IB Salut Balearic Primary Care Health Service, Palma de Mallorca, Spain.
Primary Care Chronic Respiratory Research Unit, IdisPa Balearic Health Research Institute, Palma de Mallorca, Spain.
NPJ Prim Care Respir Med. 2016 Mar 10;26:16003. doi: 10.1038/npjpcrm.2016.3.
Asthma and chronic obstructive pulmonary disease (COPD) health status assessment tools have demonstrated their value in guiding clinical management. Their use in primary care is still suboptimal. The objective of this study was to assess the effect of an educational intervention programme on the use of the Asthma Control Test (ACT), modified Medical Research Council (mMRC) and COPD Assessment Test (CAT) among primary care settings of the Balearic Islands, Spain. In this region-wide cluster-controlled implementation study, an educational intervention on the use of respiratory health status tools was provided to primary care practices in Mallorca (intervention group). Practices in Ibiza and Menorca functioned as control practices. Written and multimedia materials were provided to all participants to educate their colleagues. Primary outcome was the difference between intervention and control practices in the percentage of practices that increased the use-and recording-of ACT, CAT and mMRC tests between the 6-month period before intervention and the 6-month period after intervention. In the intervention group, 32 out of 45 (71%) centres enhanced the total number of tests, compared with 4 out of 12 (33%) in the non-intervention group (χ(2); P=0.02). Before intervention, 399 test scores were recorded in 88,194 patients (asthma: 57,339; COPD: 30,855). After intervention, 1,576 test scores were recorded in 92,714 patients (asthma: 61,841; COPD: 30,873). An educational intervention programme targeted on primary care physicians enhances the use of respiratory health status tools and promotes behavioural changes. However, the effect is very low and difficult to measure in clinical terms.
哮喘和慢性阻塞性肺疾病（COPD）健康状况评估工具已证明其在指导临床管理方面的价值。它们在初级保健中的应用仍不理想。本研究的目的是评估在西班牙巴利阿里群岛的初级保健环境中，教育干预方案对使用哮喘控制测试（ACT）、改良医学研究委员会呼吸困难量表（mMRC）和 COPD 评估测试（CAT）的影响。在这项全区域集群对照实施研究中，对马略卡岛（干预组）的初级保健实践进行了关于呼吸健康状况工具使用的教育干预。伊比萨岛和梅诺卡岛的实践作为对照实践。为所有参与者提供了书面和多媒体材料，以教育他们的同事。主要结果是干预组和对照组之间在干预前 6 个月和干预后 6 个月期间，使用和记录 ACT、CAT 和 mMRC 测试的实践比例增加的实践百分比的差异。在干预组中，与对照组（非干预组）的 4 个（33%）相比，45 个（71%）中心增加了总测试次数（χ²；P=0.02）。在干预前，在 88194 名患者中记录了 399 次测试结果（哮喘：57339；COPD：30855）。干预后，在 92714 名患者中记录了 1576 次测试结果（哮喘：61841；COPD：30873）。针对初级保健医生的教育干预方案增强了呼吸健康状况工具的使用，并促进了行为改变。然而，其效果非常低，在临床方面难以衡量。
