在哮喘管理中医患合作的障碍：患者的经验
2010/07/06
目的：描述成人哮喘主诉有关哮喘控制过程中，其自身哮喘治疗行为及其与临床医生之间合作的经历。
方法：入选本研究的104名患者为参加一项哮喘监测临床试验的患有持续性哮喘的成人患者。所有患者由一所大型学术医疗中心的临床医生进行治疗。本试验为定量析因分析，研究哮喘患者对其哮喘相关的医疗服务的看法。作为参与者，患者每月就诊1次，通过半结构式访谈获取数据。此项研究为期1年。研究结束，患者完成一项其与临床医生交流行为的评价问卷。所有参与医生也完成一项自己与患者交流行为的评价问卷调查。
结果：对于成功的自我管理，主要存在5个障碍，包括个人约束、社会约束、交流失败、用药问题和医疗系统等，这些阻碍了其与临床医生的合作。患者最常自述的是每日哮喘处理（31％）和家庭哮喘处理（24％）中缺少与医生的交流。对临床医生的调查显示，医生在展示非语言注意力（89％）、维持互动对话 （93％）上具有较好的一致性。然而，对于哮喘处理，仅30％的医生在帮助患者做决定方面具有较好的一致性。对于根据患者个体特征进行治疗方面，仅33％的医生自述具有较好一致性。
结论：建立和维持患者与医生之间的治疗合作关系具有一定困难。需要更为广泛的干预措施来促进患者与医生间的合作，以获得对慢性疾病的长期管理的成功。
（林江涛 审校）
Newcomb PA, et al. J Asthma. 2010 Mar;47(2):192-197.
Barriers to patient-clinician collaboration in asthma management: the patient experience.
Newcomb PA, McGrath KW, Covington JK, Lazarus SC, Janson SL.
University of Texas at Arlington, School of Nursing, Arlington, Texas 76019, USA. pnewcomb@uta.edu
OBJECTIVE: To describe what adult patients with asthma report about their experiences with their own self-management behavior and working with their clinicians to control asthma.
METHODS: The study sample consisted of 104 patients with persistent asthma participating in a clinical trial on asthma monitoring. All subjects were seen by primary care clinicians of a large, academic medical center. This qualitative post hoc analysis examined the views of adults with asthma about their asthma-related health care. Patients attended monthly visits as part of their study participation, during which data were derived from semistructured interviews. All patients included in this analysis participated in the study for 1 year. At the end of study participation, patients were asked to complete an evaluation of their clinician’s communication behavior. All study clinicians were also asked to complete a self-evaluation of their own communication behavior.
RESULTS: Five major themes of barriers to successful self-management were identified, including personal constraints, social constraints, communication failures, medication issues, and health care system barriers to collaboration with their clinicians. Patients most frequently reported lack of communication surrounding issues relating to day-to-day management of asthma (31%) and home management of asthma (24%). Clinicians generally rated themselves well for consistency in showing nonverbal attentiveness (89%) and maintaining interactive conversations (93%). However, only 30% of clinicians reported consistency in helping patients make decisions about asthma management and only 33% of clinicians reported consistency in tailoring medication schedules to the patient’s routines.
CONCLUSION: These findings emphasize the difficulties of establishing and maintaining a therapeutic partnership between patients and clinicians. The results underscore the need for system-wide interventions that promote the success of a therapeutic patient-clinician relationship in order to achieve long-term success in chronic disease management.
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儿童哮喘联线（Child Asthma Link Line）：联合启动的、基于电话随访的哮喘患儿综合
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反复吸入技术的指导课改善哮喘治疗的依从性
