McDonald Vanessa M, Harrington John, Clark Vanessa L, Gibson Peter G
Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, Australia.
Dept of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, Australia.
ERJ Open Res. 2022 Aug 15;8(3). doi: 10.1183/23120541.00215-2022. eCollection 2022 Jul.
Chronic airway diseases including asthma and COPD are prevalent and high-burden conditions with the majority of patients successfully managed in the primary care setting. However, for some patients with more complex disease such as difficult-to-treat or severe asthma, or complex COPD, tertiary care is required. This review provides an overview of the successful tertiary care multidisciplinary respiratory service that operates in Newcastle, New South Wales, Australia, which has been integrated into the tertiary care outpatient clinics for almost three decades. The service is multifaceted in terms of the clinical care it provides; it includes an "Inpatient Service", "Asthma Management Service", "Difficult Airways Clinic", "Drug Administration Clinic", "Rapid Access Clinic" and "Pulmonary Rehabilitation", and has an integrated research programme. The core of the multidisciplinary approach to airway diseases is a person-centred model of care, the "Treatable Traits" approach. The staffing of this service comprises consultant physicians, respiratory advanced trainees, respiratory scientists, physiotherapists, speech pathologists, nurse specialists and a nurse consultant. Patients that present to this service undergo an initial assessment and clinical review by team members, synthesis of relevant data, and development of a diagnosis and management plan. Based on this clinical review, specific interventions are determined according to the traits identified. Over time the service has evolved to accommodate the increasing numbers of patients requiring access to the Difficult Airways Clinic assessment and therapies. This has been facilitated by partnering with the Centres of Excellence in Severe Asthma and Treatable Traits to develop educational and practice management tools.
包括哮喘和慢性阻塞性肺疾病（COPD）在内的慢性气道疾病普遍存在且负担沉重，大多数患者在初级保健机构得到成功管理。然而，对于一些患有更复杂疾病的患者，如难治性或重度哮喘，或复杂的COPD，则需要三级医疗服务。本综述概述了在澳大利亚新南威尔士州纽卡斯尔运作的成功的三级医疗多学科呼吸服务，该服务已融入三级医疗门诊近三十年。该服务在提供的临床护理方面具有多面性；它包括“住院服务”、“哮喘管理服务”、“困难气道诊所”、“药物管理诊所”、“快速通道诊所”和“肺康复”，并拥有一个综合研究项目。气道疾病多学科方法的核心是以患者为中心的护理模式，即“可治疗特征”方法。该服务的人员配备包括顾问医师、呼吸高级受训人员、呼吸科学家、物理治疗师、言语病理学家、专科护士和一名护士顾问。前来该服务的患者会接受团队成员的初步评估和临床检查，综合相关数据，并制定诊断和管理计划。基于此临床检查，根据确定的特征确定具体干预措施。随着时间的推移，该服务不断发展，以满足越来越多需要进行困难气道诊所评估和治疗的患者的需求。与重度哮喘和可治疗特征卓越中心合作开发教育和实践管理工具，促进了这一发展。
