Gillett K, Lippiett K, Astles C, Longstaff J, Orlando R, Lin S X, Powell A, Roberts C, Chauhan A J, Thomas M, Wilkinson T M
National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Respiratory Theme , Southampton , UK.
Wessex Academic Health Sciences Network (AHSN) , Portsmouth , UK.
BMJ Open Respir Res. 2016 Dec 5;3(1):e000145. doi: 10.1136/bmjresp-2016-000145. eCollection 2016.
In the UK, there is significant variation in respiratory care and outcomes. An integrated approach to the management of high-risk respiratory patients, incorporating specialist and primary care teams' expertise, is the basis for new integrated respiratory services designed to reduce this variation; however, this model needs evaluating.
To evaluate an integrated service managing high-risk respiratory patients, electronic searches for patients with asthma and chronic obstructive pulmonary disease at risk of poor outcomes were performed in two general practitioner (GP) practices in a local service-development initiative. Patients were reviewed at joint clinics by primary and secondary care professionals. GPs also nominated patients for inclusion. Reviews were delivered to best standards of care including assessments of diagnosis, control, spirometry, self-management, education, medication, inhaler technique and smoking cessation support. Follow-up of routine clinical data collected at 9-months postclinic were compared with seasonally matched 9-months prior to integrated review.
82 patients were identified, 55 attended. 13 (23.6%) had their primary diagnosis changed. In comparison with the seasonally adjusted baseline period, in the 9-month follow-up there was an increase in inhaled corticosteroid prescriptions of 23.3%, a reduction in short-acting β-agonist prescription of 33.3%, a reduction in acute respiratory exacerbations of 67.6%, in unscheduled GP surgery visits of 53.3% and acute respiratory hospital admissions reduced from 3 to 0. Only 4 patients (7.3%) required referral to secondary care. Health economic evaluation showed respiratory-related costs per patient reduced by £231.86.
Patients with respiratory disease in this region at risk of suboptimal outcomes identified proactively and managed by an integrated team improved outcomes without the need for hospital referral.
在英国，呼吸护理及治疗结果存在显著差异。将专科和初级护理团队的专业知识纳入其中的高危呼吸疾病患者综合管理方法，是旨在减少这种差异的新型综合呼吸服务的基础；然而，这种模式需要进行评估。
为评估一项管理高危呼吸疾病患者的综合服务，在一项地方服务发展计划中，对两家全科医生（GP）诊所中患有哮喘和慢性阻塞性肺疾病且预后不良风险较高的患者进行了电子检索。初级和二级护理专业人员在联合诊所对患者进行了评估。全科医生也提名患者纳入评估。评估按照最佳护理标准进行，包括诊断、控制、肺活量测定、自我管理、教育、药物治疗、吸入器技术及戒烟支持等方面的评估。将诊所后9个月收集的常规临床数据随访结果与综合评估前季节性匹配的9个月数据进行比较。
共识别出82例患者，55例前来就诊。13例（23.6%）患者的初步诊断发生了改变。与经季节性调整的基线期相比，在9个月的随访中，吸入性糖皮质激素处方增加了23.3%，短效β-激动剂处方减少了33.3%，急性呼吸加重发作减少了67.6%，全科医生非预约诊疗次数减少了53.3%，急性呼吸疾病住院人数从3例降至0例。仅4例患者（7.3%）需要转诊至二级护理机构。健康经济评估显示，每位患者的呼吸相关费用减少了231.86英镑。
该地区预后欠佳风险较高的呼吸疾病患者通过综合团队主动识别并管理，改善了治疗结果，无需转诊至医院。
