He Yingxia, Stephenson Matthew, Gu Ying, Hu Xiaojing, Zhang Mingzhi, Jin Jie
Children's Hospital of Fudan University, Shanghai, People's Republic of China.
Fudan University Centre for Evidence-based Nursing: a Joanna Briggs Institute Centre of Excellence.
JBI Database System Rev Implement Rep. 2019 May;17(5):985-1002. doi: 10.11124/JBISRIR-2017-003775.
Asthma is one of the most common diseases in children. A self-management program can effectively improve the outcomes for children with asthma and reduce the burden on healthcare services.
The aim of this project was to integrate the best evidence on asthma self-management with practice in a children's respiratory clinic and to improve compliance with best practice.
Seven audit criteria were developed for the pre- and post-audit based on the best available evidence. The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tools were used in this project.
The baseline audit showed a gap between clinical practice and the best evidence. The only criterion that achieved high compliance was provision of inhaler guidance (100%). After implementation, there were substantial improvements in compliance for many criteria. Training of clinicians increased from 13% at baseline to 67% at follow-up. Education of parents improved, with specific education about asthma triggers increasing from 55% to 100%, education about warning signs from 30% to 85% and education about effective asthma treatment options from 40% to 85%. Use of written asthma action plans increased from 0% to 25%.
Strategies developed in this project were effective at providing necessary information for parents and improved the compliance with evidence. Further implementation strategies and audits are still needed to improve the use of asthma action plans and ensure they are reviewed periodically.
哮喘是儿童中最常见的疾病之一。自我管理计划可以有效改善哮喘儿童的治疗效果，并减轻医疗服务负担。
本项目旨在将哮喘自我管理的最佳证据与儿童呼吸科诊所的实践相结合，并提高对最佳实践的依从性。
根据现有最佳证据制定了七个审核标准，用于审核前和审核后。本项目使用了乔安娜·布里格斯研究所（JBI）临床证据系统的实际应用以及将研究转化为实践的审核和反馈工具。
基线审核显示临床实践与最佳证据之间存在差距。唯一达到高依从性的标准是提供吸入器指导（100%）。实施后，许多标准的依从性有了显著提高。临床医生的培训从基线时的13%增加到随访时的67%。对家长的教育有所改善，关于哮喘触发因素的具体教育从55%增加到100%，关于警示信号的教育从30%增加到85%，关于有效哮喘治疗方案的教育从40%增加到85%。书面哮喘行动计划的使用从0%增加到25%。
本项目制定的策略有效地为家长提供了必要信息，并提高了对证据的依从性。仍需要进一步的实施策略和审核，以改善哮喘行动计划的使用并确保定期对其进行审查。
