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重度哮喘与初级保健提供者:识别患者并协调多学科护理。

Severe Asthma and the Primary Care Provider: Identifying Patients and Coordinating Multidisciplinary Care.

作者信息

Yawn Barbara P, Wechsler Michael E

机构信息

Department of Family and Community Health, University of Minnesota, Minneapolis, Minn.

Department of Medicine, National Jewish Health, Denver, Colo; The Cohen Family Asthma Institute, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colo; Asthma Program, National Jewish Health, Denver, Colo.

出版信息

Am J Med. 2017 Dec;130(12):1479. doi: 10.1016/j.amjmed.2017.10.001. Epub 2017 Oct 3.

Abstract

Without proper care, patients with severe forms of asthma face substantial medical risks, marked reductions in quality of life, and other significant disease-related burdens. Therefore, it is essential that primary care clinicians and other healthcare providers are adept at identifying cases of severe asthma on the basis of symptom control, exacerbation risks, and the need for relatively aggressive treatment regimens (eg, high-dose inhaled corticosteroids with long-acting controller medications or frequent oral corticosteroid use). Engaging and educating affected individuals as part of ongoing treatment planning are best achieved with a good understanding of patients' own insights into their disease and management challenges that often arise in busy healthcare practices. This includes effectively communicating with patients about the implications of their diagnosis and potential treatment strategies that can be accessed via coordinated multidisciplinary care. Expert primary care and specialist faculty have highlighted strategies to identify cases of severe asthma, appropriate referral pathways for these individuals, and considerations on integrating patients' perspectives into clinical decision making across the continuum of care (access to an accredited educational program on these topics is available at http://courses.elseviercme.com/pcp/687). Additionally, this online program is a component of a larger platform of education activities and consolidated clinical resources designed to improve the care of patients with respiratory disorders (http://respiratorycme.elsevierresource.com/).

摘要

若未得到妥善护理,重症哮喘患者将面临重大医疗风险、生活质量显著下降以及其他与疾病相关的重大负担。因此,基层医疗临床医生和其他医疗服务提供者必须善于根据症状控制、急性加重风险以及采用相对积极的治疗方案(如高剂量吸入性糖皮质激素联合长效控制药物或频繁口服糖皮质激素)的必要性来识别重症哮喘病例。在持续的治疗规划中,要让受影响的个体参与并接受教育,最好的方法是充分了解患者对自身疾病的见解以及在繁忙的医疗实践中经常出现的管理挑战。这包括与患者就其诊断的影响以及可通过协调多学科护理获得的潜在治疗策略进行有效沟通。基层医疗专家和专科教员强调了识别重症哮喘病例的策略、针对这些患者的适当转诊途径,以及在整个护理过程中将患者观点纳入临床决策的考量因素(有关这些主题的认可教育课程可登录http://courses.elseviercme.com/pcp/687获取)。此外,该在线课程是一个更大的教育活动和综合临床资源平台的组成部分,旨在改善对呼吸系统疾病患者的护理(http://respiratorycme.elsevierresource.com/)。

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