哮喘患者住院治疗的专科护理：一项基于人群的回顾性研究。
Specialist Care in Individuals with Asthma Who Required Hospitalization: A Retrospective Population-Based Study.
机构信息
The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada; ICES, Ontario, Canada.
The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada.
出版信息
J Allergy Clin Immunol Pract. 2021 Oct;9(10):3686-3696. doi: 10.1016/j.jaip.2021.06.018. Epub 2021 Jun 26.
BACKGROUND
Patients who are at risk for severe asthma exacerbations should receive specialist care. However, the care pattern for such patients in the real world is unclear.
OBJECTIVE
To describe the pattern of care among individuals with asthma who required hospitalization, and to identify factors associated with receiving asthma specialist care.
METHODS
This was a retrospective population-based study using health administrative data from two Canadian provinces. Individuals aged 14 to 45 years who were newly diagnosed with asthma between 2006 and 2016 and had at least one hospitalization for asthma at or within 5 years after the initial asthma diagnosis were included. First, we calculated frequencies of primary and specialist care around the asthma diagnosis: 1 year before and 2 years after in a 6-month period. Next, among individuals diagnosed with asthma by a primary care physician, we used multivariable Cox regressions to identify factors associated with receiving specialist care.
RESULTS
For 1862 individuals included, we found that most (≥71% per time period) were cared for by primary care physicians 1 year before and 2 years after the asthma diagnosis; the percentage of individuals seen at least once by a specialist for asthma and/or asthma-related respiratory conditions during the first 6 months since the diagnosis did not exceed 40%. Among 1411 of 1862 individuals who were under primary care before the asthma diagnosis (76%), controlling for covariates, living in a rural area or a low-income neighborhood was associated with less likelihood of receiving specialist care.
CONCLUSIONS
Despite recommendations, more than half of individuals with asthma who required hospitalization did not receive specialist care during the first 2 years since the diagnosis. Identified factors associated with receiving asthma specialist care suggested that access is an important barrier to receiving recommended care.
背景
有发生严重哮喘恶化风险的患者应接受专科护理。然而，在现实世界中，此类患者的护理模式尚不清楚。
目的
描述需要住院治疗的哮喘患者的护理模式，并确定与接受哮喘专科护理相关的因素。
方法
这是一项使用来自加拿大两个省份的健康管理数据的回顾性基于人群的研究。纳入年龄在 14 至 45 岁之间、在 2006 年至 2016 年间首次被诊断为哮喘且在初次诊断哮喘后 5 年内至少有一次因哮喘住院的患者。首先，我们计算了哮喘诊断前后 1 年（6 个月内）的初级和专科护理的频次。其次，在由初级保健医生诊断为哮喘的患者中，我们使用多变量 Cox 回归来确定与接受专科护理相关的因素。
结果
对于纳入的 1862 名患者，我们发现大多数患者（≥每个时间段的 71%）在哮喘诊断前 1 年和诊断后 2 年内均由初级保健医生提供护理；在诊断后 6 个月内，至少有一次接受过哮喘和/或与哮喘相关的呼吸系统疾病专科治疗的患者比例不超过 40%。在 1862 名患者中有 1411 名（76%）在哮喘诊断前接受初级保健，在控制了混杂因素后，居住在农村或低收入社区与接受专科护理的可能性降低相关。
结论
尽管有建议，但超过一半需要住院治疗的哮喘患者在诊断后的前 2 年内未接受专科护理。与接受哮喘专科护理相关的确定因素表明，获得护理的机会是接受推荐护理的一个重要障碍。
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