Flokstra-de Blok Bertine Mj, van der Molen Thys, Christoffers Wianda A, Kocks Janwillem Wh, Oei Richard L, Oude Elberink Joanne Ng, Roerdink Emmy M, Schuttelaar Marie Louise, van der Velde Jantina L, Brakel Thecla M, Dubois Anthony Ej
Department of General Practice; GRIAC Research Institute.
Department of Dermatology.
J Asthma Allergy. 2017 Mar 15;10:57-65. doi: 10.2147/JAA.S123260. eCollection 2017.
Management of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs) are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS) for primary care.
Through literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists' allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE)-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard) and AMSS diagnostic categories.
The two-page patient-completed AMSS questionnaire consists of 12 (mainly) multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other allergies were identified, and the corresponding management recommendations were formulated. The agreement between the allergy specialists' assessments and the AMSS was 69.2% (CI 67.2-71.2).
Using a systematic approach, it was possible to develop an AMSS that allows for the formulation of diagnostic and management recommendations for GPs managing allergic patients. The AMSS thus holds promise for the improvement of the quality of primary care for this increasing group of patients.
由于病情复杂性和患病率的增加，对人群中过敏患者的管理变得愈发困难。尽管全科医生（GPs）有望在过敏患者的护理中发挥重要作用，但他们往往觉得自己没有足够的能力来完成这项任务。因此，本研究的目的是为初级保健开发一个过敏管理支持系统（AMSS）。
通过文献综述、对二级和初级保健患者的访谈及测试，过敏症专科医生、皮肤科医生、全科医生和研究人员根据初级保健和专科医生的过敏指南及其临床知识，构建了一份过敏史问卷。利用AMSS问卷的回答模式和特异性免疫球蛋白E（sIgE）测试结果来确定诊断类别并制定相应的管理建议。通过比较专科医生（金标准）和AMSS的诊断类别来调查AMSS的有效性。
这份由患者填写的两页AMSS问卷包含12个（主要是）关于症状、触发因素、严重程度和用药情况的多项选择题。根据118名患者的AMSS问卷和sIgE测试结果，确定了约150种过敏性鼻炎、哮喘、特应性皮炎、过敏反应、食物过敏、膜翅目昆虫过敏和其他过敏的诊断类别，并制定了相应的管理建议。过敏专科医生的评估与AMSS之间的一致性为69.2%（CI 67.2 - 71.2）。
采用系统的方法，有可能开发出一种AMSS，可为管理过敏患者的全科医生制定诊断和管理建议。因此，AMSS有望提高对这一不断增加的患者群体的初级保健质量。
