University of California San Diego School of Medicine, La Jolla, California.
Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
Respir Care. 2019 Mar;64(3):292-298. doi: 10.4187/respcare.06302. Epub 2018 Sep 25.
Reports show that many patients do not use their pressurized metered-dose inhalers (pMDIs) effectively. The National Heart, Lung, and Blood Institute recommends that health-care providers educate and assess patients' pMDI technique at each opportunity. However, limited data exist regarding how often pediatric primary care providers perform assessments and which methods they use. We sought to (1) identify instructional methods used to teach pMDI use, (2) describe how pMDI use is reassessed at follow-up visits, and (3) describe primary care provider attitudes and barriers to in-office pMDI instruction.
A 34-item electronic survey was distributed from August to December 2016 via E-mail to local pediatric primary care providers. Descriptive statistics were used for analysis.
Sixty two of 223 potential primary care providers (28%) responded. Physicians and nurse practitioners were identified most often as the providers of pMDI education (53%). When first prescribing a pMDI, only 10% reported having the patient practice inhaler use in the office and receive feedback. Only 19% "always" reassessed the technique, even for patients with poorly controlled asthma. Among those who reassessed the technique, most (76%) did so verbally, and only 42% asked the patients to demonstrate pMDI use. Only 32% reported that typical patient education in their setting was adequate to ensure proper pMDI use. Commonly cited barriers included time (84%) and access to demo pMDIs (67%). Provider solutions included video tutorials and access to demo inhalers.
Many pediatric primary care providers did not demonstrate or have patients practice pMDI use when teaching or assessing pMDI technique, and the reassessment rate was low even for patients with poorly controlled asthma. Identifying and training a consistent pMDI educator and obtaining demo pMDIs may abate some barriers. Respiratory therapists could appropriately fulfill this educator role. Brief, repeated pMDI practice for motor learning could promote more stable pMDI mastery.
报告显示，许多患者无法有效地使用他们的压力定量吸入器（pMDI）。美国国立心肺血液研究所建议医疗保健提供者在每个机会都对患者的 pMDI 技术进行教育和评估。然而，关于儿科初级保健提供者进行评估的频率以及他们使用的方法，数据有限。我们试图（1）确定用于教授 pMDI 使用的教学方法，（2）描述在随访就诊时如何重新评估 pMDI 使用情况，以及（3）描述初级保健提供者对在办公室进行 pMDI 指导的态度和障碍。
一项 34 项的电子调查于 2016 年 8 月至 12 月通过电子邮件分发给当地儿科初级保健提供者。采用描述性统计进行分析。
在 223 名潜在的初级保健提供者中，有 62 名（28%）做出了回应。医生和护士从业者被确定为 pMDI 教育的提供者（53%）。首次开具 pMDI 处方时，只有 10%的人报告让患者在办公室练习吸入器使用并获得反馈。即使对于哮喘控制不佳的患者，只有 19%的人“总是”重新评估技术。在那些重新评估技术的人中，大多数（76%）是通过口头进行的，只有 42%的人要求患者演示 pMDI 使用。只有 32%的人报告说，他们所在环境的典型患者教育足以确保正确使用 pMDI。常见的障碍包括时间（84%）和获得演示 pMDI（67%）。提供者的解决方案包括视频教程和演示吸入器的使用。
许多儿科初级保健提供者在教授或评估 pMDI 技术时没有演示或让患者练习 pMDI 使用，即使对于哮喘控制不佳的患者，重新评估率也很低。确定和培训一致的 pMDI 教育者并获得演示 pMDI 可能会缓解一些障碍。呼吸治疗师可以适当担任该教育者角色。为运动学习进行简短、重复的 pMDI 练习可以促进更稳定的 pMDI 掌握。
