Levy Mark L
Sessional general practitioner, London, UK.
Breathe (Sheff). 2015 Mar;11(1):14-24. doi: 10.1183/20734735.008914.
The 2014 UK National Review of Asthma Deaths identified potentially preventable factors in two-thirds of the medical records of cases scrutinised45% of people who died from asthma did not call for or receive medical assistance in their final fatal attackOverall asthma management, acute and chronic, in primary and secondary care was judged to be good in less than one-fifth of those who diedThere was a failure by doctors and nurses to identify and act on risk factors for asthma attacks and asthma deathThe rationale for diagnosing asthma was not evident in a considerable number of cases, and there were inaccuracies related to the completion of medical certificates of the cause of death in over half of the cases considered for the UK National Review of Asthma Deaths.
To increase awareness of some of the findings of the recent UK National Review of Asthma Deaths and previous similar studiesTo emphasise the need for accurate diagnosis of asthma, and of the requirements for completion of medical certificates of the cause of deathTo consider areas for improving asthma care and prevention of attacks and avoidable deaths.
Despite the development and publication of evidence-based asthma guidelines nearly three decades ago, potentially preventable factors are repeatedly identified in studies of the care provided for patients who die from asthma. The UK National Review of Asthma Deaths (NRAD), a confidential enquiry, was no exception: major preventable factors were identified in two-thirds of asthma deaths. Most of these factors, such as inappropriate prescription and failure to provide patients with personal asthma action plans (PAAPs), could possibly have been prevented had asthma guidelines been implemented. NRAD involved in-depth scrutiny by clinicians of the asthma care for 276 people who were classified with asthma as the underlying cause of death in real-life. A striking finding was that a third of these patients did not actually die from asthma, and many had no recorded rationale for an asthma diagnosis. The apparent complacency with respect to asthma care, highlighted in NRAD, serves as a wake-up call for health professionals, patients and their carers to take asthma more seriously. Based on the NRAD evidence, the report made 19 recommendations for change. The author has selected six areas related to the NRAD findings for discussion and provides suggestions for change in the provision of asthma care. The six areas are: systems for provision and optimisation of asthma care, diagnosis, identifying risk, implementation of guidelines, improved patient education and self-management, and improved quality of completion of medical certificates of the cause of death.
2014年英国哮喘死亡病例全国审查发现，在三分之二经审查的病例医疗记录中存在潜在可预防因素。45%死于哮喘的人在其最终致命发作时未呼叫或未获得医疗救助。在不到五分之一的死亡病例中，初级和二级医疗保健机构对哮喘的整体管理（包括急性和慢性管理）被判定为良好。医生和护士未能识别哮喘发作和哮喘死亡的风险因素并采取相应行动。在相当多的病例中，哮喘诊断的基本原理并不明确，并且在英国哮喘死亡病例全国审查所考虑的一半以上病例中，与死亡原因医学证明的填写存在不准确之处。
提高对近期英国哮喘死亡病例全国审查及以往类似研究的一些结果的认识。强调准确诊断哮喘以及填写死亡原因医学证明的要求。思考改善哮喘护理以及预防发作和避免可避免死亡的领域。
尽管近三十年前就已制定并发布了基于证据的哮喘指南，但在对死于哮喘患者的护理研究中，仍反复发现潜在可预防因素。英国哮喘死亡病例全国审查（NRAD）是一项保密调查，也不例外：在三分之二的哮喘死亡病例中发现了主要可预防因素。如果实施哮喘指南，大多数这些因素，如处方不当和未为患者提供个人哮喘行动计划（PAAP），可能本可避免。NRAD涉及临床医生对276名在现实生活中被归类为以哮喘为根本死因的患者的哮喘护理进行深入审查。一个惊人的发现是，这些患者中有三分之一实际上并非死于哮喘，而且许多患者没有记录哮喘诊断的基本原理。NRAD中凸显的对哮喘护理明显的自满情绪，为卫生专业人员、患者及其护理人员敲响了警钟，提醒他们更严肃地对待哮喘。基于NRAD的证据，该报告提出了19项变革建议。作者选取了与NRAD结果相关的六个领域进行讨论，并为改善哮喘护理提供了变革建议。这六个领域是：哮喘护理的提供和优化系统、诊断、识别风险、指南的实施、改善患者教育和自我管理以及提高死亡原因医学证明的填写质量。
