From the New York University Langone-Long Island, Mineola, New York; and.
New York University-Long Island School of Medicine, Mineola, New York.
Allergy Asthma Proc. 2022 Sep 1;43(5):454-460. doi: 10.2500/aap.2022.43.220057.
The cumulative burden of cutaneous, inhaled, intranasal and systemic corticosteroids (CS) in individual patients should be routinely assessed. Our monitoring tool collected data on CS type, potency, frequency, side effects, interventions and patient counseling in every encounter. 82 AD patients had 151 encounters. Severe AD had more side effects than those without (68.18% vs 41.67% respectively, P < 0.0333). Those with higher TSB had more side effects overall (p < 0.0493). There was also significant positive correlation with higher TSB and the overall number of side effects (p < 0.0116). 101 asthmatics had 193 encounters. Over 50% of asthma patients had other CS. Severe asthmatics had more side effects than those without (62.5% vs 20.8%, p < 0.0001). Patients with higher TSB had more side effects overall (p < 0.0001). There was also significant positive correlation with a higher TSB and the overall number of side effects (p < 0.0001). 80% of AD and 90% of asthma patients were satisfied with the counseling. The EHR in AD and asthma resulted in counseling in 89% and 93% respectively and real-time intervention in 27.8% and 3% respectively. Although patients with side effects had more dose adjustments, those without side effects also warranted adjustments. Physician surveys demonstrated improved satisfaction with the EHR tool over time, and minimal impact on visit time. The utilization of our EHR monitoring tool allows for the identification and tracking of TSB in patients, associated side effects and leads to real-time physician intervention.
应定期评估个体患者的皮肤、吸入、鼻内和全身皮质类固醇（CS）的累积负担。我们的监测工具在每次就诊时收集 CS 类型、效力、频率、副作用、干预措施和患者咨询的数据。82 名 AD 患者有 151 次就诊。严重 AD 的副作用发生率高于非严重 AD（分别为 68.18%和 41.67%，P<0.0333）。TSB 较高的患者总体副作用发生率更高（p<0.0493）。TSB 与总体副作用数量之间也存在显著正相关（p<0.0116）。101 名哮喘患者有 193 次就诊。超过 50%的哮喘患者使用了其他 CS。严重哮喘患者的副作用发生率高于非严重哮喘患者（62.5%和 20.8%，p<0.0001）。TSB 较高的患者总体副作用发生率更高（p<0.0001）。TSB 与总体副作用数量之间也存在显著正相关（p<0.0001）。80%的 AD 和 90%的哮喘患者对咨询感到满意。AD 和哮喘的 EHR 分别导致 89%和 93%的患者接受咨询，27.8%和 3%的患者实时干预。尽管有副作用的患者需要更多剂量调整，但没有副作用的患者也需要调整。医生调查显示，随着时间的推移，EHR 工具的满意度有所提高，对就诊时间的影响很小。我们的 EHR 监测工具的使用可以识别和跟踪患者的 TSB、相关副作用，并导致医生实时干预。
