"Centro Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili di Brescia, Brescia, Italy.
Laboratorio per la Salute Materno Infantile. Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Ital J Pediatr. 2017 Jun 24;43(1):58. doi: 10.1186/s13052-017-0374-8.
Due to the lack of real life clinical and educational studies, "Io e l'Asma" Centre performed this implementation research (IR). Evaluate long-term effectiveness on bronchial asthma control of an integrated clinical and educational pathway for asthmatic children and adolescents.
An observational retrospective pre-post intervention IR study was conducted among 262 children with asthma, ages 6-15 yrs. The intervention protocol included three clinical visits 8 weeks apart; an educational course at visit 1, post intervention consisted in two follow-up visits 6 months apart. The primary outcome was to verify the percentage of children who achieved bronchial asthma control at each visit. Secondary outcomes were based on daily therapy modulation, hospital admissions and the number of school days missed. An economic assessment was also included.
Two hundred sixty two children with bronchial asthma completed the pathway and were included in the analysis. The percentage of children who obtained disease control increased from 44% at visit 1 to 79% at visit 3 and at 1-year follow-up was 83%. Hospital admissions represent 11% of children: 8% before the intervention, 2% during the intervention, and 1% before and during the intervention; no hospitalizations related to bronchial asthma exacerbations were reported during the 2 follow-up visits.
The therapeutic-educational pathway was adapted according to the international guidelines and the primary performance indicators. Our findings confirmed that the clinical plus educational approach, shared between specialists and family physicians, is an effective template for asthma management. These findings also demonstrated a strong economic advantage.
由于缺乏真实生活中的临床和教育研究，"Io e l'Asma" 中心进行了这项实施研究（IR）。评估综合临床和教育途径对哮喘儿童和青少年支气管哮喘控制的长期效果。
对 262 名年龄在 6-15 岁的哮喘儿童进行了观察性回顾性干预前后实施研究。干预方案包括 3 次 8 周间隔的临床访视；在第 1 次访视时进行教育课程，干预后每隔 6 个月进行 2 次随访。主要结局是验证每次访视时达到支气管哮喘控制的儿童比例。次要结局基于每日治疗调节、住院和缺课天数。还包括经济评估。
262 名患有支气管哮喘的儿童完成了该途径并被纳入分析。获得疾病控制的儿童比例从第 1 次访视的 44%增加到第 3 次访视的 79%，在 1 年随访时达到 83%。住院儿童占 11%：干预前为 8%，干预期间为 2%，干预前后为 1%；在 2 次随访期间，没有因哮喘恶化而住院的病例。
治疗教育途径根据国际指南和主要绩效指标进行了调整。我们的研究结果证实，专家和家庭医生共同实施的临床加教育方法是一种有效的哮喘管理模板。这些结果还表明了具有强大的经济效益。
