Bosnic-Anticevich Sinthia, Callan Christina, Chrystyn Henry, Lavorini Federico, Nikolaou Vasilis, Kritikos Vicky, Dekhuijzen P N Richard, Roche Nicolas, Bjermer Leif, Rand Cynthia, Zwar Nicholas, Price David B
a Woolcock Institute of Medical Research, University of Sydney , Sydney , Australia.
b Sydney Local Health District , Sydney , Australia.
J Asthma. 2018 Jan;55(1):79-88. doi: 10.1080/02770903.2017.1310227. Epub 2017 Apr 28.
Healthcare professionals (HCPs) are required to assess and train patients in the correct use of inhalers but are often unable to demonstrate correct technique themselves. We sought to assess the level of training required for HCPs to master and maintain device mastery when using two different dry powder inhalers (DPIs).
We conducted a randomized, un-blinded, crossover study in undergraduate HCPs who undertook a six-step training procedure (intuitive use, patient information leaflet, instructional video, individual tuition from expert, then two repeats of individual tuition) for the use of Turbuhaler® (an established device) and Spiromax® (a newer device, reportedly easier to use). Device mastery (absence of errors) was evaluated by expert assessors at each training step. Maintenance of mastery was assessed 4 ± 1 week (visit 2) and 8 ± 2 weeks (visit 3) after initial training (visit 1).
Of 516 eligible participants, 113 (22%) demonstrated device mastery prior to training on Spiromax® compared with 20 (4%) on Turbuhaler® (p < 0.001). The median number of training steps required to achieve mastery was 2 (interquartile range [IQR] 2-4) for Spiromax® and 3 (IQR 2-4) for Turbuhaler® (p < 0.001). A higher number of participants maintained mastery with Spiromax® compared with Turbuhaler®, at visits 2 and 3 (64% vs 41% and 79% vs 65%, respectively; p < 0.001).
There are significant differences in the nature and extent of training required to achieve and maintain mastery for Spiromax® and Turbuhaler® devices. The implications on clinical practice, device education delivery, and patient outcomes require further evaluation.
医疗保健专业人员（HCPs）需要评估并培训患者正确使用吸入器，但他们自己往往无法演示正确的操作技巧。我们试图评估HCPs在使用两种不同的干粉吸入器（DPI）时掌握并维持设备操作熟练程度所需的培训水平。
我们对本科阶段的HCPs进行了一项随机、非盲、交叉研究，这些HCPs针对使用都保®（一种已有的设备）和思力华®（一种较新的设备，据报道更容易使用）进行了六步培训程序（直观使用、患者信息手册、教学视频、专家个人指导，然后是两次个人指导重复）。在每个培训步骤由专家评估人员评估设备操作熟练程度（无错误）。在初始培训（访视1）后4±1周（访视2）和8±2周（访视3）评估熟练程度的维持情况。
在516名符合条件的参与者中，113名（22%）在使用思力华®培训前就已展示出设备操作熟练，而使用都保®的这一比例为20名（4%）（p<0.001）。达到熟练所需的培训步骤中位数，思力华®为2（四分位间距[IQR]2 - 4），都保®为3（IQR 2 - 4）（p<0.001）。与都保®相比，在访视2和访视3时，更多参与者使用思力华®维持了熟练程度（分别为64%对41%和79%对65%；p<0.001）。
在实现和维持思力华®和都保®设备熟练程度所需培训的性质和程度上存在显著差异。对临床实践、设备教育提供和患者结局的影响需要进一步评估。
