哮喘联盟

   摘要
   引言：以前的研究已经表明低等社会经济地位与频繁的哮喘发作相关。然而，最近没有多中心研究保险状况-一种社会经济地位的代表方式-成人哮喘的严重与管理之间的关系。研究目的是通过美国成人急诊的保险状态，调查急性与慢性哮喘管理的差异。
   方法：我们进行了一项多中心急诊患者回顾研究（美国23个州的48急诊），年龄18-54岁，在2011和2012年之间患有急性哮喘。每一个中心都进行培训（讲座，练习图表，认证），然后再随机选择图表。根据他们的基本健康保险，我们将患者分为三组：私人保险，公共保险和没有保险。结果评价指标是通过之前的索引访问，慢性哮喘严重程度（如1年时间≥2急诊），在急诊的急性哮喘管理，急诊出院处方。
   结果：分析队列包括1928例患有急性哮喘的急诊患者。其中，有33%人有私人保险，40%有公共保险，27%人没有保险。与私人保险的患者相比，那些公共保险或者没有保险的人更可能在过去一年中有大于等于2次的急诊（分别是35%，49%，和45%；P＜0.001）。尽管慢性严重性较高，那些没有保险的人不太可能有指导方针推荐的慢性哮喘护理-如低剂量使用吸入糖皮质激素（ICS[41%, 41%, and 29%; p<0.001]）和哮喘专科护理（9%，10%，和4%; p<0.001）。相比之下，保险状态不同，急诊的急性哮喘管理并没有显著差异，如全身使用糖皮质激素（75%，79%，和78%，P =0.08）或急诊出院处方开始使用低剂量糖皮质激素（12%，12%，和14%，p= 0.57）。
   结论：在这项多中心急诊急性哮喘患者观察性研究中，我们发现，不同保险状态的慢性哮喘严重性和管理存在显著差异。与之相比，不同保险的急性哮喘管理无显著差异。

 

（苏欣 审校）
West J Emerg Med. 2016 Jan;17(1):22-7. doi: 10.5811/westjem.2015.11.28715. Epub 2016 Jan 12.
 

Association of Insurance Status with Severity and Management in ED Patients with Asthma Exacerbation.
 

Hasegawa K1, Stoll SJ2, Ahn J1, Kysia RF3, Sullivan AF1, Camargo CA Jr1.
 

Abstract
INTRODUCTION:Previous studies have demonstrated an association of low socioeconomic status with frequent asthma exacerbations. However, there have been no recent multicenter efforts to examine the relationship of insurance status - a proxy for socioeconomic status - with asthmaseverity and management in adults. The objective is to investigate chronic and acute asthma management disparities by insurance status among adults requiring emergency department (ED) treatment in the United States.
METHODS:We conducted a multicenter chart review study (48 EDs in 23 U.S. states) on ED patients, aged 18-54 years, with acute asthmabetween 2011 and 2012. Each site underwent training (lecture, practice charts, certification) before reviewing randomly selected charts. We categorized patients into three groups based on their primary health insurance: private, public, and no insurance. Outcome measures were chronicasthma severity (as measured by ≥2 ED visits in one-year period) and management prior to the index ED visit, acute asthma management in the ED, and prescription at ED discharge.
RESULTS:The analytic cohort comprised 1,928 ED patients with acute asthma. Among these, 33% had private insurance, 40% had public insurance, and 27% had no insurance. Compared to patients with private insurance, those with public insurance or no insurance were more likely to have ≥2 ED visits during the preceding year (35%, 49%, and 45%, respectively; p<0.001). Despite the higher chronic severity, those with no insurance were less likely to have guideline-recommended chronic asthma care - i.e., lower use of inhaled corticosteroids (ICS [41%, 41%, and 29%; p<0.001]) and asthma specialist care (9%, 10%, and 4%; p<0.001). By contrast, there were no significant differences in acute asthma management in the ED - e.g., use of systemic corticosteroids (75%, 79%, and 78%; p=0.08) or initiation of ICS at ED discharge (12%, 12%, and 14%; p=0.57) - by insurance status.
CONCLUSION:In this multicenter observational study of ED patients with acute asthma, we found significant discrepancies in chronic asthmaseverity and management by insurance status. By contrast, there were no differences in acute asthma management among the insurance groups.

 

West J Emerg Med. 2016 Jan;17(1):22-7. doi: 10.5811/westjem.2015.11.28715. Epub 2016 Jan 12.