Orozco-Beltrán Domingo, Carratalá-Munuera Concepción, Arriero Juan M, Campo Paloma, Martínez-Moragón Eva, Molina Jesús, Quintano-Jiménez José Antonio, Gil-Guillén Vicente F
Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain.
Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Alicante, Spain,
Fam Pract. 2016 Dec;33(6):678-683. doi: 10.1093/fampra/cmw081. Epub 2016 Aug 20.
Over 50% of treated patients with asthma in Europe are not well controlled. Their management in primary health care (PHC) differs from that in specialized care, and there is no real coordination between the two.
To identify barriers and solutions to improving the management of patients with severe and poorly controlled asthma and the communication between specialists and PHC, and to reach a consensus on the criteria for referral patients.
An observational study using a modified Delphi technique. About 79 physicians from PHC, pneumology and allergy fields from different Spanish regions were invited to participate via an online questionnaire. Consensus was reached on an item when more than two-thirds of the panel members scored within the 3-point category (1-3 or 7-9) containing the median and the interquartile range of answers had to be ≤4 points.
Response rate: 52%. After the second round, consensus items were 40 (62.5%): of which 37 in agreement and 3 in disagreement. Around 92.68% of respondents agreed that it would be useful to incorporate questionnaires for asthma control into PHC computer-based searches. About 100% of participants agreed that clear consensus criteria between PHC and specialists must be determined to decide when a patient with asthma is referred from PHC to specialist or vice versa. Ten of the proposed criteria reached consensus agreement.
The failure to use guidelines and specific questionnaires for asthma control in PHC is one reason why there is underdiagnosis and poor control of asthma. Some strategies to improve the asthma care management emerged from the survey results.
在欧洲，超过50%接受治疗的哮喘患者病情未得到良好控制。他们在初级卫生保健（PHC）中的管理与专科护理不同，且两者之间没有真正的协调。
确定改善重度和控制不佳的哮喘患者管理以及专科医生与初级卫生保健之间沟通的障碍和解决方案，并就患者转诊标准达成共识。
采用改良德尔菲技术进行观察性研究。通过在线问卷邀请了来自西班牙不同地区的约79名初级卫生保健、肺病学和过敏领域的医生参与。当超过三分之二的小组成员在包含中位数且答案的四分位间距必须≤4分的3分类别（1 - 3或7 - 9）内评分时，就某一项目达成共识。
回复率：52%。第二轮后，达成共识的项目有40项（62.5%）：其中37项达成一致，3项存在分歧。约92.68%的受访者同意将哮喘控制问卷纳入初级卫生保健基于计算机的搜索中会很有用。约100%的参与者同意必须确定初级卫生保健和专科医生之间明确的共识标准，以决定哮喘患者何时从初级卫生保健转诊至专科医生或反之亦然。所提议的标准中有10项达成了共识。
在初级卫生保健中未使用哮喘控制指南和特定问卷是哮喘诊断不足和控制不佳的一个原因。调查结果提出了一些改善哮喘护理管理的策略。
