Anderson H R, Bailey P, West S
Br Med J. 1980 Nov 1;281(6249):1191-4. doi: 10.1136/bmj.281.6249.1191.
In the South-west Thames Region over the period 1970-8 the number of admissions for asthma in children aged 5-14 years increased from 256 to 684, an increase of 167%. Factors associated with this trend were investigated by an analysis of routine hospital statistics and examination of case notes for 1970 and 1978 from every hospital in the region. The trend was caused partly by an increase in readmission rates. There was a more than fivefold increase in self-referrals; these patients had less severe asthma on admission and a higher readmission rate than patients referred by general practitioners. Drug management before and after admission changed considerably over the nine years, as did hospital investigations. Overall, there was little change in the level of severity on admission. The increase in admissions was not associated with a reduction in deaths from asthma in the region and occurred in spite of major advances in the drug control of asthma; this indicates an inadequacy of ambulatory care. The shift in the balance of care towards the hospital and the increasing adoption of a primary care function by the hospital indicate a need for hospitals and general practice to agree jointly on management policies for acute asthma.
在1970年至1978年期间，泰晤士河西南部地区5至14岁儿童因哮喘入院的人数从256人增加到684人，增幅为167%。通过对常规医院统计数据进行分析，并查阅该地区各医院1970年和1978年的病历，对与这一趋势相关的因素进行了调查。这种趋势部分是由再入院率上升导致的。自行转诊的人数增加了五倍多；这些患者入院时哮喘病情较轻，但再入院率高于由全科医生转诊的患者。在这九年里，入院前后的药物管理以及医院检查都发生了很大变化。总体而言，入院时的严重程度水平变化不大。入院人数的增加与该地区哮喘死亡率的降低并无关联，尽管在哮喘药物控制方面取得了重大进展，但这种情况依然发生了；这表明门诊护理存在不足。医疗护理重心向医院转移，以及医院越来越多地承担起初级护理职能，这表明医院和全科医疗需要就急性哮喘的管理政策达成共同协议。
