Jayaram Lata, Gillman Andrew, Casanelia Sue, Yee Valerie, Hocking Valerie, Wasgewatta Sanjiwika, Reid-Price Lynnette, Botlero Roslin, Southcott Anne Marie
Department of Respiratory Medicine, Western Health, Melbourne, Victoria, Australia.
Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
Health Promot J Austr. 2023 Apr;34(2):429-436. doi: 10.1002/hpja.620. Epub 2022 Jun 5.
Recurrent asthma admissions are frequent in our patients at a tertiary Australian hospital and are commonly related to poor health literacy and medication adherence. A need exists to improve these asthma self-management skills within our current model of care, especially during the vulnerable postdischarge period.
To examine if the addition of a nurse-led Asthma Care Transition Team (ACTT) compared with usual care alone (UC) (1) improves asthma control at 12 weeks posthospital discharge; the number of patients using a Written Action Plan (WAP), compliance with inhaler therapy at 12 weeks, and readmission rates at 6 months.
Adults admitted with asthma were randomised to either: UC: involving review of asthma medication and self-management skills by the ward team prior to discharge; a standard 6-week post discharge clinic visit and a 12-week study visit where an independent assessor assessed outcomes; or ACTT: In addition to UC, involved ACTT nurse-led review at 1 week and 6 weeks. Key aspects included a pre defined, structured review reinforcing education and self-management skills, and telephone support during working hours.
Sixty participants (UC and ACTT) had similar baseline characteristics: Mean age: 41 vs 38 years, asthma duration: 20 vs 18 years, baseline Asthma Control Questionnaire 3.1 vs 3.4. At 12 weeks Asthma Control Questionnaire (ACQ) improved significantly in both groups but more so with ACTT; ACTT group had a higher uptake of WAP and a trend to reduced readmissions.
A nurse-led ACTT improves asthma control and self-management skills following discharge and may lead to fewer readmissions.
在澳大利亚一家三级医院，我们的患者中哮喘反复入院情况很常见，且通常与健康素养低和药物依从性差有关。在我们当前的护理模式中，尤其是在出院后的脆弱期，有必要提高这些哮喘自我管理技能。
研究与单纯常规护理（UC）相比，增加一个由护士主导的哮喘护理过渡团队（ACTT）是否（1）能在出院后12周改善哮喘控制；使用书面行动计划（WAP）的患者数量、12周时吸入器治疗的依从性以及6个月时的再入院率。
因哮喘入院的成年人被随机分为两组：UC组：在出院前由病房团队对哮喘药物和自我管理技能进行评估；标准的出院后6周门诊随访和12周研究随访，由独立评估者评估结果；或ACTT组：除UC组措施外，在第1周和第6周由ACTT护士主导进行评估。关键方面包括强化教育和自我管理技能的预定义结构化评估，以及工作时间的电话支持。
60名参与者（UC组和ACTT组）具有相似的基线特征：平均年龄：41岁对38岁，哮喘病程：20年对18年，基线哮喘控制问卷评分：3.1对3.4。在12周时，两组的哮喘控制问卷（ACQ）均有显著改善，但ACTT组改善更明显；ACTT组WAP的使用率更高，且再入院率有降低趋势。
由护士主导的ACTT可改善出院后的哮喘控制和自我管理技能，并可能减少再入院次数。
