Lyons R A, Rodgers S E, Thomas S, Bailey R, Brunt H, Thayer D, Bidmead J, Evans B A, Harold P, Hooper M, Snooks H
Swansea University Medical School, Swansea, UK.
Cwm Taf Public Health Team, Public Health Wales, Keir Hardie University Health Park, Merthyr Tydfil, UK.
J Epidemiol Community Health. 2016 Dec;70(12):1184-1190. doi: 10.1136/jech-2016-207222. Epub 2016 May 23.
There is no evidence to date on whether an intervention alerting people to high levels of pollution is effective in reducing health service utilisation. We evaluated alert accuracy and the effect of a targeted personal air pollution alert system, airAware, on emergency hospital admissions, emergency department attendances, general practitioner contacts and prescribed medications.
Quasi-experimental study describing accuracy of alerts compared with pollution triggers; and comparing relative changes in healthcare utilisation in the intervention group to those who did not sign-up. Participants were people diagnosed with asthma, chronic obstructive pulmonary disease (COPD) or coronary heart disease, resident in an industrial area of south Wales and registered patients at 1 of 4 general practices. Longitudinal anonymised record linked data were modelled for participants and non-participants, adjusting for differences between groups.
During the 2-year intervention period alerts were correctly issued on 208 of 248 occasions; sensitivity was 83.9% (95% CI 78.8% to 87.9%) and specificity 99.5% (95% CI 99.3% to 99.6%). The intervention was associated with a 4-fold increase in admissions for respiratory conditions (incidence rate ratio (IRR) 3.97; 95% CI 1.59 to 9.93) and a near doubling of emergency department attendance (IRR=1.89; 95% CI 1.34 to 2.68).
The intervention was associated with increased emergency admissions for respiratory conditions. While findings may be context specific, evidence from this evaluation questions the benefits of implementing near real-time personal pollution alert systems for high-risk individuals.
目前尚无证据表明提醒人们注意高污染水平的干预措施在减少医疗服务利用方面是否有效。我们评估了警报的准确性以及针对性的个人空气污染警报系统“空气感知”（airAware）对急诊入院、急诊科就诊、全科医生诊疗及处方药使用的影响。
采用准实验研究，将警报准确性与污染触发因素进行比较，并比较干预组与未注册用户在医疗服务利用方面的相对变化。参与者为被诊断患有哮喘、慢性阻塞性肺疾病（COPD）或冠心病的患者，居住在南威尔士的一个工业区，且在4家全科诊所中的1家注册就诊。对参与者和非参与者的纵向匿名记录链接数据进行建模，并对组间差异进行调整。
在为期2年的干预期内，248次警报中有208次正确发出；灵敏度为83.9%（95%可信区间78.8%至87.9%），特异度为99.5%（95%可信区间99.3%至99.6%）。该干预措施与呼吸系统疾病入院人数增加4倍相关（发病率比（IRR）3.97；95%可信区间1.59至9.93），急诊科就诊人数几乎翻倍（IRR = 1.89；95%可信区间1.34至2.68）。
该干预措施与呼吸系统疾病急诊入院人数增加相关。虽然研究结果可能因具体情况而异，但本次评估的证据对为高危个体实施近实时个人污染警报系统的益处提出了质疑。
