Siddiqui Madiha, Khan Fizra, Saeed Saima
Madiha Siddiqui, FCPS The Indus Hospital & Health Network, Plot 3 & 3-A, Sector 47 Korangi Creek Road, Karachi, Pakistan.
Fizra Khan, BE The Indus Hospital & Health Network, Plot 3 & 3-A, Sector 47 Korangi Creek Road, Karachi, Pakistan.
Pak J Med Sci. 2024 Jan;40(2ICON Suppl):S42-S46. doi: 10.12669/pjms.40.2(ICON).8945.
Task shifting, an approach to address physician shortage through redistribution of clinical tasks, may help address the high burden of chronic respiratory diseases like asthma and COPD. We aimed to measure its utility and impact in the Obstructive Lung Disease program (OLD).
A retrospective, cross-sectional study was conducted at five integrated outpatient departments of Primary Care Program within Indus Hospital & Health Network, Pakistan, from January 2018 to March 2023. After a formative evaluation, registered nurses were trained as Lung Health Nurses (LHNs) to perform spirometry, collect Patient Reported Outcome Measures (PROMs) including Asthma Control Test (ACT), modified Medical Research Council (mMRC) dyspnea score and COPD Assessment Test (CAT), counsel on inhaler use and tobacco cessation, and refer to pulmonary rehabilitation (PR). Data was collected online contemporaneously on REDCap and later analyzed using Excel and STATA 14.
Pre-implementation, a monthly average of 126 asthmatics and 33 COPD patients visited primary care centers. Medical records of 147 OLD patients showed 8% received inhaler education, 3% completed ACT and 2% had mMRC documented. Implementation included capacity building of nine LHNs. Of 7427 referrals to the program, 86% underwent nurse-led assessments. LHNs performed spirometry (92%), PROMs assessments [ACT (89%), CAT (91%), mMRC (85%)], inhaler education (97%), tobacco cessation advice (85%) and made PR referrals (94%).
Trained nurses can play a role in providing holistic and timely care for patients with CRDs and strengthen existing healthcare systems. Future directions may include expanding nurse clinical counselling roles through telehealth monitoring and home management.
任务转移是一种通过重新分配临床任务来解决医生短缺问题的方法，可能有助于应对哮喘和慢性阻塞性肺疾病（COPD）等慢性呼吸道疾病的高负担。我们旨在衡量其在阻塞性肺病项目（OLD）中的效用和影响。
2018年1月至2023年3月，在巴基斯坦印度河医院及健康网络初级保健项目的五个综合门诊部进行了一项回顾性横断面研究。经过形成性评估后，注册护士被培训为肺部健康护士（LHN），以进行肺活量测定、收集患者报告结局测量指标（PROMs），包括哮喘控制测试（ACT）、改良医学研究委员会（mMRC）呼吸困难评分和慢性阻塞性肺疾病评估测试（CAT），提供吸入器使用和戒烟咨询，并转诊至肺康复（PR）。数据在REDCap上同步在线收集，随后使用Excel和STATA 14进行分析。
在实施前，初级保健中心每月平均有126名哮喘患者和33名慢性阻塞性肺疾病患者就诊。147名OLD患者的病历显示，8%的患者接受了吸入器教育，3%的患者完成了ACT，2%的患者记录了mMRC。实施内容包括对9名LHN进行能力建设。在该项目的7427次转诊中，86%接受了护士主导的评估。LHN进行了肺活量测定（92%）、PROMs评估[ACT（89%）, CAT（91%）, mMRC（85%）]、吸入器教育（97%）、戒烟建议（85%）并进行了肺康复转诊（94%）。
经过培训的护士可以在为慢性呼吸道疾病患者提供全面及时的护理方面发挥作用，并加强现有的医疗保健系统。未来的方向可能包括通过远程医疗监测和家庭管理来扩大护士的临床咨询角色。
