Janson S, Becker G
Department of Community Health Systems, School of Nursing, University of California, San Francisco 94143-0608, USA.
J Asthma. 1998;35(5):427-35. doi: 10.3109/02770909809048951.
Increased morbidity and mortality due to asthma suggested the need to investigate whether persons with asthma report delay in seeking medical care during acute asthma exacerbations and the reasons they gave for delay. We interviewed 95 asthmatic adults, 36 men and 59 women, using a critical incident technique to discover how patients responded to acute asthma symptom episodes. Subjects were interviewed once per month for a total of three interviews. All subjects had physician-diagnosed asthma for a mean of 16.8+/-14.5 years. Eighty-six percent of the sample (n=82) reported delay in seeking medical care for severe asthma symptoms. Seven reasons for delay were identified: uncertainty, disruption, minimization, fear of systemic corticosteroid, previous bad experiences in emergency departments, the need to "tough it out" alone, and economic reasons. Seventy-one subjects (86.5%) reported three or more reasons for delay. Thirteen subjects (16%) identified pivotal episodes in which they realized they could die from asthma and as a result, no longer delayed. People with asthma often delay seeking urgent care for acute episodes for a variety of reasons. Some of these reasons are modifiable. Clear directions from health professionals to guide patients in responding to acute asthma episodes are needed. Asthma action plans written by the primary physician may be a positive agent of change for those who delay.
哮喘导致的发病率和死亡率上升，这表明有必要调查哮喘患者在急性哮喘发作时是否报告就医延迟以及他们给出的延迟原因。我们采用关键事件技术对95名成年哮喘患者（36名男性和59名女性）进行了访谈，以了解患者对急性哮喘症状发作的反应。受试者每月接受一次访谈，共进行三次。所有受试者经医生诊断患有哮喘，平均患病时间为16.8±14.5年。86%的样本（n = 82）报告称，在出现严重哮喘症状时就医延迟。确定了七个延迟原因：不确定性、干扰、轻视、对全身用糖皮质激素的恐惧、之前在急诊科的糟糕经历、需要独自“挺过去”以及经济原因。71名受试者（86.5%）报告了三个或更多延迟原因。13名受试者（16%）指出了关键事件，在这些事件中他们意识到自己可能死于哮喘，因此不再延迟。哮喘患者因各种原因在急性发作时常常延迟寻求紧急治疗。其中一些原因是可以改变的。需要卫生专业人员给出明确指示，以指导患者应对急性哮喘发作。由初级医生制定的哮喘行动计划可能是促使那些延迟就医的患者改变的积极因素。
