Oyama Baku, Tsuburai Takahiro, Komase Yuko, Ono Ayami, Muraoka Hiromi, Shinozaki Yusuke, Nishiyama Kazuhiro, Ueno Junko, Nishi Yoshihiro, Numata Yu, Usuba Ayano Tsukune, Yamaguchi Hiromichi, Hida Naoya
Department of Respiratory Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital.
Department of Respiratory Medicine, St. Marianna University School of Medicine.
Arerugi. 2022;71(8):934-943. doi: 10.15036/arerugi.71.934.
Our hospital in the western part of Yokohama City managed adult bronchial asthma patients via a coordinated care system with primary care clinics. The aim of the system is to provide effective daily and emergency medical care.
The study comprised 288 adult stable asthmatics (201 women) who were examined at Yokohama City Seibu Hospital between Jan 2009 and May 2018 and who were being managed under our coordinated care system at one of 80 primary clinics or hospitals.
Of the 288 patients enrolled, 188 continued, 37 ended under management, and 63 dropped out from this system. The drop-out rate was highest at visit 1 (9%). The main reasons for end of cooperation under management were readjustment of asthma treatment and treatment for other diseases. The reasons for dropping out were low adherence, older age, and mild symptoms. There was a significant tendency in the frequency of patients who continued, ended under management, or dropped out (x: 26.053, p=0.016), and the drop-out rate was significantly higher at visit 1. Comparing the characteristics of the patients who continued, ended under management, and dropped out within two visit, those who had dropped out were significantly younger (p=0.0067) and their duration of asthma was shorter (p=0.0009). The frequencies of emergency department visit and hospitalization were high until visit 2, but no significant trends were observed.
Our coordinated care system managed 188 asthmatic patients (65.2%) properly. Patients with low adherence tended to drop out from the system at visit 1.
我们位于横滨市西部的医院通过与基层医疗诊所的协调护理系统来管理成年支气管哮喘患者。该系统的目的是提供有效的日常和紧急医疗护理。
本研究纳入了288例成年稳定期哮喘患者（201例女性），这些患者于2009年1月至2018年5月在横滨市西部医院接受检查，并在80家基层诊所或医院中的一家接受我们的协调护理系统管理。
在纳入的288例患者中，188例继续接受管理，37例结束管理，63例退出该系统。退出率在第1次就诊时最高（9%）。管理下合作结束的主要原因是哮喘治疗调整和其他疾病治疗。退出的原因是依从性低、年龄较大和症状较轻。继续接受管理、结束管理或退出的患者频率存在显著趋势（χ²：26.053，p = 0.016），且退出率在第1次就诊时显著更高。比较在两次就诊内继续接受管理、结束管理和退出的患者特征，退出的患者明显更年轻（p = 0.0067），哮喘病程更短（p = 0.0009）。直到第2次就诊，急诊科就诊和住院频率都很高，但未观察到显著趋势。
我们的协调护理系统妥善管理了188例哮喘患者（65.2%）。依从性低的患者倾向于在第1次就诊时退出该系统。
