Legorreta A P, Christian-Herman J, O'Connor R D, Hasan M M, Evans R, Leung K M
Quality Initiatives Division, Health Net, Woodland Hills, CA 91637, USA.
Arch Intern Med. 1998 Mar 9;158(5):457-64. doi: 10.1001/archinte.158.5.457.
To improve asthma disease management, the National Asthma Education Program (NAEP) Expert Panel published Guidelines for the Diagnosis and Management of Asthma in 1991.
To compare the current status of asthma disease management among patients in a large health maintenance organization with the NAEP guidelines and to identify the factors that may be associated with medical care (eg, emergency department visits and hospital admissions) and adherence to the guidelines.
Analyses of 1996 survey data from 5580 members with asthma (age range, 14 to 65 years) covered by a major health maintenance organization in California (Health Net).
In general, adherence to NAEP guidelines was poor. Seventy-two percent of respondents with severe asthma reported having a steroid inhaler, and of those, only 54% used it daily. Only 26% of respondents reported having a peak flowmeter, and of those, only 16% used it daily. Age (older), duration of asthma (longer), increasing current severity of disease, and treatment by an asthma specialist correlated with daily use of inhaled steroids. Ethnicity (African American and Hispanic) correlated negatively with inhaled steroid use but positively with emergency department visits and hospital admissions for asthma. Increasing age and treatment by an asthma specialist were also identified as common factors significantly related to the daily use of a peak flowmeter and, interestingly, to overuse of beta2-agonist metered-dose inhalers.
Although the NAEP guidelines were published 7 years ago, compliance with the guidelines was low. It was especially poor for use of preventive medication and routine peak-flow measurement. Furthermore, the results showed that asthma specialists provided more thorough care than did primary care physicians in treating patients with asthma. Combining the results of the regression analyses revealed that some of the variation in rates of emergency department visits and hospitalizations among some subpopulations can be explained by the underuse of preventive medication. This study serves the goal of documenting the quality of care and services currently provided to patients with asthma through a large health maintenance organization and provides baseline information that can be used to design and assess effective population-based asthma disease management intervention programs.
为改善哮喘疾病管理，国家哮喘教育计划（NAEP）专家小组于1991年发布了《哮喘诊断与管理指南》。
比较一家大型健康维护组织中患者的哮喘疾病管理现状与NAEP指南，并确定可能与医疗护理（如急诊就诊和住院）及指南依从性相关的因素。
对加利福尼亚州一家主要健康维护组织（健康网络）所覆盖的5580名哮喘患者（年龄范围14至65岁）的1996年调查数据进行分析。
总体而言，对NAEP指南的依从性较差。72%的重度哮喘受访者报告有类固醇吸入器，其中只有54%的人每天使用。只有26%的受访者报告有峰值流量计，其中只有16%的人每天使用。年龄较大、哮喘病程较长、当前疾病严重程度增加以及由哮喘专科医生治疗与吸入性类固醇的每日使用相关。种族（非裔美国人和西班牙裔）与吸入性类固醇的使用呈负相关，但与哮喘急诊就诊和住院呈正相关。年龄增长和由哮喘专科医生治疗也被确定为与每日使用峰值流量计显著相关的常见因素，有趣的是，还与β2激动剂定量吸入器的过度使用相关。
尽管NAEP指南在7年前就已发布，但对指南的依从性较低。在预防性药物使用和常规峰值流量测量方面尤其差。此外，结果表明，哮喘专科医生在治疗哮喘患者方面比初级保健医生提供了更全面的护理。综合回归分析结果显示，一些亚人群中急诊就诊率和住院率的差异部分可由预防性药物使用不足来解释。本研究旨在记录通过一家大型健康维护组织目前为哮喘患者提供的护理和服务质量，并提供可用于设计和评估有效的基于人群的哮喘疾病管理干预项目的基线信息。
