临床实践中哮喘的环境管理：2012年国家门诊医疗调查结果
Environmental management of asthma in clinical practice: Results from the 2012 National Ambulatory Medical Care Survey.
作者信息
Salo Paivi M, Akinbami Lara J, Cloutier Michelle M, Wilkerson Jesse C, Elward Kurtis S, Mazurek Jacek M, Diette Gregory B, Mitchell Tracey A, Williams Sonja, Zeldin Darryl C
机构信息
Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md.
出版信息
J Allergy Clin Immunol Glob. 2023 Nov 22;3(1):100192. doi: 10.1016/j.jacig.2023.100192. eCollection 2024 Feb.
BACKGROUND
The National Asthma Education and Prevention Program guidelines emphasize environmental control as an integral part of asthma management; however, limited national-level data exist on how clinicians implement environmental control recommendations.
OBJECTIVE
We analyzed data on clinicians' self-reported use of recommended environmental control practices in a nationally representative sample (n = 1645) of primary care physicians, asthma specialists, and advanced practice providers from the National Asthma Survey of Physicians, a supplemental questionnaire to the 2012 National Ambulatory Medical Care Survey.
METHODS
We examined clinician and practice characteristics as well as clinicians' decisions and strategies regarding environmental trigger assessment and environmental control across provider groups. Regression modeling was used to identify clinician and practice characteristics associated with implementation of guideline recommendations.
RESULTS
A higher percentage of specialists assessed asthma triggers at home, school, and/or work than primary care or advanced practice providers (almost always: 53.6% vs 29.4% and 23.7%, respectively, < .001). Almost all clinicians (>93%) recommended avoidance of secondhand tobacco smoke, whereas recommendations regarding cooking appliances (eg, proper ventilation) were infrequent. Although assessment and recommendation practices differed between clinician groups, modeling results showed that clinicians who reported almost always assessing asthma control were 5- to 6-fold more likely to assess environmental asthma triggers. Use of asthma action plans was also strongly associated with implementation of environmental control recommendations.
CONCLUSIONS
Environmental assessment and recommendations to patients varied among asthma care providers. High adherence to other key guideline components, such as assessing asthma control, was associated with environmental assessment and recommendation practices on environmental control.
背景
国家哮喘教育与预防计划指南强调环境控制是哮喘管理的一个重要组成部分；然而，关于临床医生如何实施环境控制建议的国家级数据有限。
目的
我们分析了来自医生全国哮喘调查的全国代表性样本（n = 1645）的初级保健医生、哮喘专家和高级执业提供者自我报告的推荐环境控制措施使用情况的数据，该调查是2012年国家门诊医疗护理调查的补充问卷。
方法
我们研究了临床医生和执业特征，以及各医疗服务提供者群体在环境触发因素评估和环境控制方面的临床医生决策和策略。采用回归模型来确定与指南建议实施相关的临床医生和执业特征。
结果
与初级保健医生或高级执业提供者相比，更高比例的专家在家中、学校和/或工作场所评估哮喘触发因素（几乎总是：分别为53.6%、29.4%和23.7%，P <.001）。几乎所有临床医生（>93%）都建议避免接触二手烟草烟雾，而关于烹饪器具（如适当通风）的建议则很少。尽管不同临床医生群体的评估和建议做法存在差异，但模型结果显示，报告几乎总是评估哮喘控制情况的临床医生评估环境哮喘触发因素的可能性要高5至6倍。使用哮喘行动计划也与环境控制建议的实施密切相关。
结论
哮喘护理提供者对患者的环境评估和建议各不相同。对其他关键指南组成部分（如评估哮喘控制）的高度依从性与环境控制方面的环境评估和建议做法相关。
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