基层医疗中治疗困难和严重的哮喘：教育项目的实施和评估。

Difficult-to-treat and severe asthma in general practice: delivery and evaluation of an educational program.

机构信息

NPS MedicineWise, PO Box 1147, Strawberry Hills, NSW, 2012, Australia.

Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, 2006, Australia.

出版信息

BMC Fam Pract. 2019 Jul 13;20(1):99. doi: 10.1186/s12875-019-0991-y.

DOI:10.1186/s12875-019-0991-y

PMID:31301742

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6626400/

Abstract

BACKGROUND

Asthma, a common yet complex airway disorder affecting about 11% of Australians, is well-controlled in only 54% of people with asthma. Those with difficult-to-treat and severe asthma are more likely to experience recurrent and potentially life-threatening exacerbations. It is therefore important that GPs can initiate a systematic approach for the management of patients with difficult-to-treat asthma to identify those whose condition may improve by addressing contributory factors and those who require specialist input. We therefore aimed to develop and deliver an educational program for GPs on the systematic management of patients with difficult-to-treat and severe asthma and evaluate the effectiveness of this program.

METHODS

We developed an educational program on the management of difficult-to-treat and severe asthma in primary care that was delivered to GPs and other health professionals between January and June 2018. We evaluated the effectiveness of the program using a retrospective pre-test with post-survey, administered to GPs directly after program participation.

RESULTS

Over 1000 general practice health professionals participated in the educational program, including 890 GPs of whom 226 (25%) completed the survey. Following program participation, a greater proportion of GPs identified factors they would assess in managing a patient with poor asthma control, particularly for considering the risk of future adverse outcomes (+ 51%), changes in lifestyle (+ 38%), and self-management strategies (+ 35%). GPs indicated a greater awareness of the biologic therapies that specialists could consider prescribing to their patients with severe asthma (+ 75%), of the requirements for a patient to be prescribed a biologic therapy (+ 73%) and that patients with different phenotypic characteristics can respond differently to standard therapy (+ 67%). The proportion of GPs who would refer appropriate patients to a specialist also significantly increased.

CONCLUSIONS

This study suggests that an evidence-based educational program can improve GP knowledge, confidence and intended practice in managing patients with difficult-to-treat and severe asthma.

摘要

背景

哮喘是一种常见但复杂的气道疾病，影响着约 11%的澳大利亚人，然而仅有 54%的哮喘患者能够得到良好控制。那些治疗困难和严重的哮喘患者更有可能经历反复且潜在危及生命的恶化。因此，对于全科医生来说，启动一种系统性的方法来管理治疗困难的哮喘患者非常重要，以便确定那些通过解决促成因素病情可能改善的患者，以及那些需要专科医生介入的患者。因此，我们旨在为全科医生制定并提供一个关于治疗困难和严重哮喘的系统性管理的教育项目，并评估该项目的有效性。

方法

我们制定了一个关于初级保健中治疗困难和严重哮喘管理的教育项目，并于 2018 年 1 月至 6 月期间向全科医生和其他卫生专业人员提供。我们使用直接在项目参与后进行的回顾性预测试后调查来评估该项目的有效性。

结果

超过 1000 名普通实践卫生专业人员参加了该教育项目，其中包括 890 名全科医生，其中 226 名（25%）完成了调查。在参与项目后，更多的全科医生确定了他们在管理控制不佳的哮喘患者时将评估的因素，特别是考虑未来不良后果的风险（增加了 51%）、生活方式的改变（增加了 38%）和自我管理策略（增加了 35%）。全科医生表示，他们对专科医生可能会为其严重哮喘患者开的生物疗法有了更高的认识（增加了 75%），对患者需要开生物疗法的要求也有了更高的认识（增加了 73%），而且不同表型特征的患者对标准治疗的反应可能不同（增加了 67%）。愿意将合适的患者转介给专科医生的全科医生的比例也显著增加。