哮喘联盟

   摘要
   背景：有哮喘相关住院病史的患者存在再度入院的高风险，而且通常消耗着大量的医疗保健资源。患者发生一次哮喘相关性住院后，由专业人员提供的二级护理是否比由普通医师提供的初级护理具有更好的预后，目前尚不得而知。
   方法：采用加拿大不列单哥伦比亚省以人群为基础统计的政府健康数据，研究者建立了趋势积分相匹配的患者队列，他们在哮喘相关性住院治疗出院后的60天内接受了初级或二级护理，比较接下来12个月中两种护理方式下的哮喘相关直接总费用（主要结果）和医疗服务使用情况及药物治疗的依从性（次要结果）。
   结果：初级护理组和二次护理组的2088例患者的基本情况相似。初级护理组和二级护理组在哮喘相关直接总费用（差别是567美元，[95%CI -276美元-1410美元]）和再住院率（率比=1.06 [95%CI 0.85-1.32]）方面无差异。二级护理组的哮喘患者拥有更高的哮喘相关门诊治疗率(率比=1.22 [95%CI 1.11-1.35])，但短效β-受体激动剂使用率更低(率比=0.91 [95%CI 0.85-0.98])。二级护理组的控制药物治疗天数比例更高。
   讨论：与仅接受了初级护理的患者相比，接受二级护理的患者拥有更为恰当的治疗。不过，再住院率的费用和风险没有差别。鉴于两组哮喘治疗的药物依从性较差，有必要提高普通医师和专业人员等的医疗服务质量。
 

（苏楠 审校）
Chest. 2013 Mar 21. doi: 10.1378/chest.12-2773. [Epub ahead of print]

 

Costs and health outcomes associated with primary versus secondary care after anasthma-related hospitalization, a population-based study.

Sadatsafavi M, Fitzgerald M, Marra C, Lynd L.

Abstract
ABSTRACT BACKGROUND:Patients with a history of asthma-related hospitalization are at high risk of readmission and generally consume a large amount of health care resources. It is not clear if secondary care provided by specialists after an episode of asthma-related hospitalization is associated with better outcomes compared with primary care provided by general practitioners.
METHODS:Using population-based administrative health data in the province of British Columbia, Canada, we created a propensity-score-matched cohort of individuals who received primary versus secondary care in the 60 days after discharge from an episode of asthma-related hospitalization. Total direct asthma-related medical costs (primary outcome) and health service use and measures of medication adherence (secondary outcomes) were compared for the next twelve months.
RESULTS:2,088 individuals were equally matched between the primary and secondary care groups. There was no difference in the direct asthma-related costs (difference $567 [95%CI -$276-$1410]) and rate of readmission (rate ratio [RR]= 1.06 [95%CI 0.85-1.32]) between secondary versus primary care groups. Patients under secondary care had a higher rate of asthma-related outpatient service use (RR=1.22 [95%CI 1.11-1.35]) but lower rate of short acting beta-agonist dispensation (RR=0.91 [95%CI 0.85-0.98]). Proportion of days covered with a controller medication was higher among the secondary care group (difference of 3.2%[95%CI 0.4%-6.0%]).
DISCUSSION:Compared with those who received only primary care, patients who received secondary care showed evidence of more appropriate treatment. Nevertheless, there were no differences in costs and risk of readmission. Adherence to asthma medication in both groups was poor, indicating the need for raising the quality of care provided by generalists and specialists alike.
 

Chest. 2013 Mar 21. doi: 10.1378/chest.12-2773. [Epub ahead of print]