基层医疗中哮喘和COPD客观检测的障碍和促成因素：一项使用理论领域框架的系统综述
2021/11/24
摘要
背景：尽管指南长期以来一直建议通过客观肺功能测试来诊断哮喘和慢性阻塞性肺病（COPD），但许多基层医疗患者在没有客观测试的情况下被诊断哮喘或COPD。这通常会导致不必要的治疗，随之而来的是相关费用和副作用的增加，以及实际诊断的延误。
研究问题：基层医疗中哮喘和/或COPD肺功能测试的障碍和促成因素是什么？
研究设计和方法：我们检索了报导基层医疗中进行办公室或办公室外肺功能测试诊断哮喘和/或COPD的障碍和/或促成因素的定性和定量研究的文献。两名审稿人独立筛选摘要和全文；使用混合方法评估工具评估方法质量；并从纳入研究中提取数据。使用理论领域框架（TDF），应用预先制定的编码手册，对确定的障碍和使能因素进行分类。
结果：我们确定了7988篇文章，回顾了336篇全文文章，并在本系统综述中纳入了18项研究。在这18项中，12项是定量的，3项是定性的，3项使用了混合方法。所有18项都涉及办公室测试，11项也涉及办公室外测试。哮喘和慢性阻塞性肺病以及办公室内外环境的障碍和促成因素重叠。我们发现了相比于促成因素（如进行可靠肺活量测定的技能）更多的障碍因素（如缺乏肺活量测定有用性的知识）。障碍因素反映到了9个（可能14个）TDF域（用于办公室内外设置）。促成因素反映到三个进行办公室内测试域，五个进行办公室外测试域。
解释：基层医疗中气道疾病客观检测的障碍是复杂的，并且跨越许多理论领域。相应地，成功的干预必须利用多种行为改变技术。现在应该开发和测试一种基于理论的多方面干预措施，以解决哮喘或COPD诊断测试使用不足的问题。
Barriers and Enablers to Objective Testing for Asthma and COPD in Primary Care: A Systematic Review Using the Theoretical Domains Framework
Janet Yamada, Jeffrey Lam Shin Cheung, Myriam Gagne, Carolyn Spiegel-Feld, Shawn D Aaron, J Mark FitzGerald, Andrea Gershon, Samir Gupta
Abstract
Background: Although guidelines have long recommended objective pulmonary function testing to diagnose asthma and chronic obstructive lung disease (COPD), many primary care patients receive a clinical diagnosis of asthma or COPD without objective testing. This often leads to unnecessary treatment with associated incremental costs and side-effects, and delays actual diagnosis.
Research question: What are the barriers and enablers to lung function testing for asthma and/or COPD in primary care?
Study design and methods: We searched the literature for qualitative and quantitative studies reporting barriers and/or enablers to in-office or out-of-office lung function testing for diagnosing asthma and/or COPD, in primary care. Two reviewers independently screened abstracts and full texts; assessed methodological quality using the Mixed Methods Appraisal Tool; and extracted data from included studies. Identified barriers and enablers were categorized using the Theoretical Domains Framework (TDF), applying a pre-established coding manual.
Results: We identified 7988 unique articles, reviewed 336 full-text articles, and included 18 studies in this systematic review. Of these 18, 12 were quantitative, 3 were qualitative, and 3 used mixed methods. All 18 addressed in-office testing and 11 also addressed out-of-office testing. Barriers and enablers overlapped for asthma and COPD, and in- and out-of-office settings. We identified more reported barriers (e.g. lack of knowledge of the usefulness of spirometry) than enablers (e.g. skills for performing reliable spirometry). Barriers mapped to 9 (of a possible 14) TDF domains (for both in- and out-of-office settings). Enablers mapped to three domains for in-office testing and five domains for out-of-office testing.
Interpretation: Barriers to objective testing for airways disease in primary care are complex and span many theoretical domains. Correspondingly, a successful intervention must leverage multiple behaviour change techniques. A theory-based, multifaceted intervention to address underuse of diagnostic testing for asthma or COPD should now be developed and tested.
背景：尽管指南长期以来一直建议通过客观肺功能测试来诊断哮喘和慢性阻塞性肺病（COPD），但许多基层医疗患者在没有客观测试的情况下被诊断哮喘或COPD。这通常会导致不必要的治疗，随之而来的是相关费用和副作用的增加，以及实际诊断的延误。
研究问题：基层医疗中哮喘和/或COPD肺功能测试的障碍和促成因素是什么？
研究设计和方法：我们检索了报导基层医疗中进行办公室或办公室外肺功能测试诊断哮喘和/或COPD的障碍和/或促成因素的定性和定量研究的文献。两名审稿人独立筛选摘要和全文；使用混合方法评估工具评估方法质量；并从纳入研究中提取数据。使用理论领域框架（TDF），应用预先制定的编码手册，对确定的障碍和使能因素进行分类。
结果：我们确定了7988篇文章，回顾了336篇全文文章，并在本系统综述中纳入了18项研究。在这18项中，12项是定量的，3项是定性的，3项使用了混合方法。所有18项都涉及办公室测试，11项也涉及办公室外测试。哮喘和慢性阻塞性肺病以及办公室内外环境的障碍和促成因素重叠。我们发现了相比于促成因素（如进行可靠肺活量测定的技能）更多的障碍因素（如缺乏肺活量测定有用性的知识）。障碍因素反映到了9个（可能14个）TDF域（用于办公室内外设置）。促成因素反映到三个进行办公室内测试域，五个进行办公室外测试域。
解释：基层医疗中气道疾病客观检测的障碍是复杂的，并且跨越许多理论领域。相应地，成功的干预必须利用多种行为改变技术。现在应该开发和测试一种基于理论的多方面干预措施，以解决哮喘或COPD诊断测试使用不足的问题。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(Chest. 2021 Nov 2;S0012-3692(21)04256-2. doi: 10.1016/j.chest.2021.10.030.)
(Chest. 2021 Nov 2;S0012-3692(21)04256-2. doi: 10.1016/j.chest.2021.10.030.)
Barriers and Enablers to Objective Testing for Asthma and COPD in Primary Care: A Systematic Review Using the Theoretical Domains Framework
Janet Yamada, Jeffrey Lam Shin Cheung, Myriam Gagne, Carolyn Spiegel-Feld, Shawn D Aaron, J Mark FitzGerald, Andrea Gershon, Samir Gupta
Abstract
Background: Although guidelines have long recommended objective pulmonary function testing to diagnose asthma and chronic obstructive lung disease (COPD), many primary care patients receive a clinical diagnosis of asthma or COPD without objective testing. This often leads to unnecessary treatment with associated incremental costs and side-effects, and delays actual diagnosis.
Research question: What are the barriers and enablers to lung function testing for asthma and/or COPD in primary care?
Study design and methods: We searched the literature for qualitative and quantitative studies reporting barriers and/or enablers to in-office or out-of-office lung function testing for diagnosing asthma and/or COPD, in primary care. Two reviewers independently screened abstracts and full texts; assessed methodological quality using the Mixed Methods Appraisal Tool; and extracted data from included studies. Identified barriers and enablers were categorized using the Theoretical Domains Framework (TDF), applying a pre-established coding manual.
Results: We identified 7988 unique articles, reviewed 336 full-text articles, and included 18 studies in this systematic review. Of these 18, 12 were quantitative, 3 were qualitative, and 3 used mixed methods. All 18 addressed in-office testing and 11 also addressed out-of-office testing. Barriers and enablers overlapped for asthma and COPD, and in- and out-of-office settings. We identified more reported barriers (e.g. lack of knowledge of the usefulness of spirometry) than enablers (e.g. skills for performing reliable spirometry). Barriers mapped to 9 (of a possible 14) TDF domains (for both in- and out-of-office settings). Enablers mapped to three domains for in-office testing and five domains for out-of-office testing.
Interpretation: Barriers to objective testing for airways disease in primary care are complex and span many theoretical domains. Correspondingly, a successful intervention must leverage multiple behaviour change techniques. A theory-based, multifaceted intervention to address underuse of diagnostic testing for asthma or COPD should now be developed and tested.
上一篇：
宏基因组学联合代谢组学共同揭示螨过敏儿童哮喘患者气道微生物群的特定特征及功能
下一篇：
维持吸入糖皮质激素对哮喘患者SARS-CoV-2受体ACE2的上调作用
