Hoskins G, Neville R G, Smith B, Clark R A
Tayside Centre for General Practice, University of Dundee.
Br J Gen Pract. 1996 Mar;46(404):169-71.
Self-management plans may help patients with asthma intervene when symptoms deteriorate, thus preventing asthma attacks.
A study set out to test whether a self-management plan tailored to the circumstances of the individual reduces morbidity from asthma.
General practitioners who had participated in a national audit of asthma attacks were randomized into intervention and control groups. Six months after the intervention group had issued self-management plans to patients with asthma, both groups of practitioners completed morbidity questionnaires on patients. Morbidity outcomes were compared for the 6-month periods before and after the issue of the plans.
In the 6 months before the study, the 376 patients enrolled by the intervention group experienced higher levels of morbidity than the 530 patients for whom details were recorded by the control group. In the 6 months after the issue of the plans, control group patients showed little change in levels of morbidity, but intervention group patients showed significant reductions in hospital admissions, consultations for asthma symptoms, asthma review consultations, courses of oral steroids and use of emergency nebulized bronchodilators.
General practitioners appeared to operate enthusiast bias' and issued more self-management plans to patients with uncontrolled asthma. The reduction in morbidity in this group is probably a result of the use of the plans, but the verdict on whether plans reduce morbidity must be deemed 'not proven'.
自我管理计划可能有助于哮喘患者在症状恶化时进行干预，从而预防哮喘发作。
一项研究旨在测试针对个体情况量身定制的自我管理计划是否能降低哮喘发病率。
参与全国哮喘发作审计的全科医生被随机分为干预组和对照组。干预组向哮喘患者发放自我管理计划6个月后，两组医生都完成了关于患者发病率的问卷调查。比较计划发放前后6个月的发病率结果。
在研究前的6个月里，干预组登记的376名患者的发病率高于对照组记录详细信息的530名患者。在计划发放后的6个月里，对照组患者的发病率变化不大，但干预组患者的住院次数、因哮喘症状的就诊次数、哮喘复查就诊次数、口服类固醇疗程以及紧急雾化吸入支气管扩张剂的使用均显著减少。
全科医生似乎存在“热情偏差”，向哮喘控制不佳的患者发放了更多的自我管理计划。该组发病率的降低可能是使用这些计划的结果，但关于计划是否能降低发病率的结论必须被视为“未证实”。
