Yawn Barbara P, Rank Matthew A, Cabana Michael D, Wollan Peter C, Juhn Young J
Department of Research, Olmsted Medical Center, Rochester, MN.
Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, AZ.
Mayo Clin Proc. 2016 Apr;91(4):411-21. doi: 10.1016/j.mayocp.2016.01.010. Epub 2016 Mar 1.
To assess primary care adherence to 2007 US asthma guidelines.
Patients with persistent asthma aged 5 to 65 years from 22 primary care participating practices provided the data for this analysis of baseline information from the pragmatic randomized clinical trial the Asthma Tools Study. Using a combination of abstracted medical record data and patient-reported demographic information, we assessed the medical record documentation for elements of the 2007 US asthma guidelines. Elements assessed included documentation of (1) assessment of control, (2) factors that affect control (medication adherence evaluation, inhaler technique education, and evaluation for triggers), (3) self-management support (action plan), and (4) asthma medications prescribed (short-acting β-agonists and daily maintenance therapy). The baseline data was collected from March 16, 2009, to May 1, 2014.
In 1176 patients (285 children, 211 tweens, and 680 adults) from 16 family medicine and 6 pediatric practices across the United States, documented guideline adherence was highest for prescription of medications (88.0% for short-acting β-agonists and 70.4% for maintenance medications) and lowest for an asthma action plan (3.1%). Documentation of control (15.0%) and factors that affect control (inhaler technique education, 7.6%; medication adherence assessment, 32.5%; and allergy evaluation, 32.5%) was not common and even less common for adults compared with children. A total of 22.2% of the enrolled patients had no asthma-related visit in the year before enrollment. Adherence to the nonmedication elements were higher in practices located in cities of more than 250,000 people and cities that used electronic medical records. Older patient age was negatively associated with guideline adherence.
Adherence to asthma guidelines is poor in primary care practices, leaving many opportunities for improvement.
评估基层医疗对2007年美国哮喘指南的遵循情况。
来自22个参与基层医疗实践的5至65岁持续性哮喘患者提供了此项实用随机临床试验——哮喘工具研究的基线信息分析数据。通过结合提取的病历数据和患者报告的人口统计学信息，我们评估了2007年美国哮喘指南各项要素的病历记录情况。评估的要素包括：（1）控制评估；（2）影响控制的因素（药物依从性评估、吸入器技术教育及触发因素评估）；（3）自我管理支持（行动计划）；（4）所开具的哮喘药物（短效β受体激动剂和每日维持治疗药物）。基线数据收集时间为2009年3月16日至2014年5月1日。
在美国16家家庭医学诊所和6家儿科诊所的1176例患者（285名儿童、211名青少年和680名成人）中，指南遵循情况记录显示，药物处方方面的遵循率最高（短效β受体激动剂为88.0%，维持治疗药物为70.4%），哮喘行动计划方面的遵循率最低（3.1%）。控制情况的记录（15.0%）以及影响控制的因素（吸入器技术教育，7.6%；药物依从性评估，32.5%；过敏评估，32.5%）并不常见，与儿童相比，成人中更少见。共有22.2%的登记患者在登记前一年没有与哮喘相关的就诊记录。在人口超过25万的城市以及使用电子病历的城市的诊所中，对非药物要素的遵循情况更高。患者年龄较大与指南遵循情况呈负相关。
基层医疗实践中对哮喘指南的遵循情况较差，有很多改进的机会。
