清除临床障碍：采用患者导向来增加哮喘治疗的社会支持
2010/11/04
摘要
背景：临床实践中，中重度哮喘患者，特别是少数族裔或穷人患者，常常在接受哮喘护理时遇到个人及卫生系统相关的障碍。
目的：本文通过研究患者及看护者的想法，旨在建立可行的、个性化的、经济的方法，通过采用患者倡导或导向，提供社会支持，以减少障碍。
方法：作者对4个焦点小组进行了研究，参与者为中重度哮喘成人患者。参与者来自于低收入人群和少数族裔的城市人群。来自于这些焦点小组的数据与其余2个焦点小组（1个护士组，1个医生组）共享。基于社会支持分类，研究者单独对所有焦点小组编码，并商定主题：仪器支持（物理辅助）、信息支持（教育辅助）、情感支持（感同身受）、确认支持（与其他人比较）。
结果：患者与看护者都认为，患者导向通过提供社会支持，有助于患者控制哮喘。两组都显示，仪器支持和信息支持最为重要。然而，患者需要更多的仪器支持，而看护者则关注信息支持。医生强调对患者病史进行回顾，而患者需要接受更多信息来管理哮喘。看护者与患者都认为，在哮喘恶化的短期护理以及慢性哮喘的长期自我管理中，都需强调患者导向在哮喘治疗中的作用。
结论：在提供医疗信息的基础上，看护者有必要与患者沟通，对患者提供相关仪器支持，以便患者对哮喘进行短期及长期自我管理。
（苏楠 审校）
J Asthma. 2010 Sep 17. [Epub ahead of print]
Clearing Clinical Barriers: Enhancing Social Support Using a Patient Navigator for Asthma Care.
Black HL, Priolo C, Akinyemi D, Gonzalez R, Jackson DS, Garcia L, George M, Apter AJ.
Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine.
Abstract
Background. Patients with moderate or severe asthma, particularly those who are minority or poor, often encounter significant personal, clinical practice, and health system barriers to accessing care.
Objective. To explore the ideas of patients and providers for potentially feasible, individualized, cost-effective ways to reduce obstacles to care by providing social support using a patient advocate or navigator.
Methods. The authors conducted four focus groups of adults with moderate or severe asthma. Participants were recruited from clinics serving low-income and minority urban neighborhoods. Data from these patient focus groups were shared with two additional focus groups, one of nurses and one of physicians. Researchers independently coded and agreed upon themes from all focus groups, which were categorized by types of social support: instrumental (physical aid), informational (educational), emotional (empathizing), validation (comparisons to others).
Results. Patients and providers agreed that a patient navigator could help patients manage asthma by giving social support. Both groups found instrumental and informational support most important. However, patients desired more instrumental help whereas providers focused on informational support. Physicians stressed review of medical information whereas patients wanted information to complete administrative tasks. Providers and patients agreed that the patient navigator’s role in asthma would need to address both short-term care of exacerbations and enhance long-term chronic self-management by working with practice personnel.
Conclusions. Along with medical information, there is a need for providers to connect patients to instrumental support relevant to acute and long-term asthma-self-management.
J Asthma. 2010 Sep 17. [Epub ahead of print]
背景：临床实践中，中重度哮喘患者，特别是少数族裔或穷人患者，常常在接受哮喘护理时遇到个人及卫生系统相关的障碍。
目的：本文通过研究患者及看护者的想法，旨在建立可行的、个性化的、经济的方法，通过采用患者倡导或导向，提供社会支持，以减少障碍。
方法：作者对4个焦点小组进行了研究，参与者为中重度哮喘成人患者。参与者来自于低收入人群和少数族裔的城市人群。来自于这些焦点小组的数据与其余2个焦点小组（1个护士组，1个医生组）共享。基于社会支持分类，研究者单独对所有焦点小组编码，并商定主题：仪器支持（物理辅助）、信息支持（教育辅助）、情感支持（感同身受）、确认支持（与其他人比较）。
结果：患者与看护者都认为，患者导向通过提供社会支持，有助于患者控制哮喘。两组都显示，仪器支持和信息支持最为重要。然而，患者需要更多的仪器支持，而看护者则关注信息支持。医生强调对患者病史进行回顾，而患者需要接受更多信息来管理哮喘。看护者与患者都认为，在哮喘恶化的短期护理以及慢性哮喘的长期自我管理中，都需强调患者导向在哮喘治疗中的作用。
结论：在提供医疗信息的基础上，看护者有必要与患者沟通，对患者提供相关仪器支持，以便患者对哮喘进行短期及长期自我管理。
（苏楠 审校）
J Asthma. 2010 Sep 17. [Epub ahead of print]
Clearing Clinical Barriers: Enhancing Social Support Using a Patient Navigator for Asthma Care.
Black HL, Priolo C, Akinyemi D, Gonzalez R, Jackson DS, Garcia L, George M, Apter AJ.
Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine.
Abstract
Background. Patients with moderate or severe asthma, particularly those who are minority or poor, often encounter significant personal, clinical practice, and health system barriers to accessing care.
Objective. To explore the ideas of patients and providers for potentially feasible, individualized, cost-effective ways to reduce obstacles to care by providing social support using a patient advocate or navigator.
Methods. The authors conducted four focus groups of adults with moderate or severe asthma. Participants were recruited from clinics serving low-income and minority urban neighborhoods. Data from these patient focus groups were shared with two additional focus groups, one of nurses and one of physicians. Researchers independently coded and agreed upon themes from all focus groups, which were categorized by types of social support: instrumental (physical aid), informational (educational), emotional (empathizing), validation (comparisons to others).
Results. Patients and providers agreed that a patient navigator could help patients manage asthma by giving social support. Both groups found instrumental and informational support most important. However, patients desired more instrumental help whereas providers focused on informational support. Physicians stressed review of medical information whereas patients wanted information to complete administrative tasks. Providers and patients agreed that the patient navigator’s role in asthma would need to address both short-term care of exacerbations and enhance long-term chronic self-management by working with practice personnel.
Conclusions. Along with medical information, there is a need for providers to connect patients to instrumental support relevant to acute and long-term asthma-self-management.
J Asthma. 2010 Sep 17. [Epub ahead of print]
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在医疗服务短缺人群中采用信息技术减少哮喘治疗差异：初步研究
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儿童和看护者对哮喘药物使用所陈述和关注的问题
