哮喘联盟

    急诊室中哮喘患者的复诊率通常较高，不充分的患者教育是高复诊率的重要原因之一。但时至今日，国际上尚未确定最佳的教育形式。为了比较以患者为中心的哮喘患者教育(patient centred education, PCE)和标准化的患者教育（standard patient education, SPE)对急诊复诊率的作用，Smith等在一个城市的两所教学医院进行了一项随机、对照研究。
    两组患者均分别接受6个主题课程，PCE组另外根据患者需要追加部分内容。最终146例因哮喘发作而急诊就医的成年哮喘患者入选研究。研究发现，4个月后，PCE组患者的急诊复诊率由22%降至12%，而SPE组没有变化（两组OR 0.4；95% CI，0.2～1.1）。而在78例由急诊出院的患者中，在4个月和12个月，PCE组的复诊率居低于SPE组（4个月：OR 0.3, 95%, CI 0.1～ 0.9; 12个月：OR 0.3, 95% CI, 0.1～ 0.8）。
    因此作者认为PCE能带来更好的控制哮喘，当然还需要大规模多中心的研究来证实。

                     (韩伟 青岛大学附属青岛市立医院东院呼吸科266071 摘译) 
                                       （Eur Respir J. 2008; 31:990-997.)

Standard versus patient centred asthma education in the Emergency Department: - a randomised study.
Smith S, Mitchell C, Bowler S

High re-attendance rates are common after asthma emergency department (ED) care. Inadequate patient education has been cited as one potential cause of re-attendances and the optimal format of education is uncertain.To compare the effectiveness of patient centred and standard asthma patient education on ED re-attendances.A randomised controlled trial at two inner city Australian teaching hospitals’ EDs where patients received either standard patient education (SPE) or patient centred education (PCE). Both groups received a six topic curriculum. However, PCE patients reordered the topics according to their own priority and controlled the order of education.One hundred forty-six adult patients presenting to EDs with acute asthma were enrolled. At 4 months, ED re-attendances decreased from 22% to 12% in PCE group and were unchanged in the SPE group (between group OR 0.4; 95% CI 0.2 to 1.1). In patients discharged after ED care (n=78), the PCE group had fewer re-attendances at 4 and 12 months (OR 0.3, 95%, CI 0.1 to 0.9; OR 0.3 95% CI 0.1 to 0.8). PCE patients with no GP care in the prior 7 days had fewer re-attendances at 4 and 12 months (OR 0.1, 95% CI 0.0 to 0.7; OR 0.2, 95% CI 0.0 to 0.6). A trend of better asthma control was evident with a reduction in activity limitation.PCE offers promise as a brief education process in the ED. However, large multi-centre trial of PCE is warranted.