哮喘联盟

   摘要
   背景：医师培训影响患者护理。
   目的：旨在比较不同儿科专科医师中的哮喘管理和FEV1占预计值百分比的变化情况。
   方法：一项回顾性队列研究，纳入从2009到2010年间来自多学科哮喘门诊≥6岁儿童，并随访到2012年，评估不同专科医师(2名儿科医师、3名儿科过敏症专科医师、5名小儿呼吸科医师)管理下的哮喘预后差异。采用单因素分析进行比较研究，参数包括过敏试验(皮肤点刺试验或抗过敏原吸收试验)、合并症、以及专科医师处方。采用多因素回归分析（控制了个别医师的随机效应），评估处方吸入糖皮质激素(ICS)和FEV1占预计值变化百分比在专业医师间的差异。
   结果：超过56%的患者(309/548)是由小儿呼吸科医师看诊的，26%由儿科过敏症专科医师看诊，18%由儿科医师看诊。医师的专业影响检查需求、并发症的诊断、治疗和FEV1的改善。儿科过敏症专科医师的病人进行了更多的过敏测试，更可能的诊断出过敏性鼻炎，因此，与儿科医师和小儿呼吸科医师相比更可能处方鼻用激素。与儿科过敏症专科医师相比，儿科医师最不可能处方ICS (比值比 0.39 [95% CI, 0.15-0.96]; P < .05)，且在FEV1占预计值百分比 ≥ 80%的儿童中ICS处方存在着最大的差异。接受儿科过敏症专科医师治疗的儿童FEV1改善情况好于接受儿科医师(13%; P < .001)和小儿呼吸科医师(8%; P = .005)治疗的儿童。
   结论：医师的专业很大程度影响了其对于患者管理的决断（检查、合并症诊断和正常肺功能儿童中的ICS治疗）。这些结果为患者水平下的哮喘管理和未来实践指南的制定提供了一些启示。
 

(林江涛 审校)
JAllergyClinImmunolPract.2014May-Jun;2(3):306-312.e5.doi:10.1016/j.jaip.2013.12.005. Epub 2014 Apr 2.


 

Physician specialty influences important aspects of pediatric asthma management.
 

Aung YN1, Majaesic C2, Senthilselvan A2, Mandhane PJ3.
 

ABSTRACT
BACKGROUND: Physician training influences patient care.
OBJECTIVE: To compare asthma management and change in the percentage predicted FEV1 among pediatric physician specialties.
METHODS: A retrospective cohort of children 6 years of age or older, seen in a multidisciplinary asthma clinic between 2009 and 2010, and followed to 2012, was completed to examine differences in asthma outcomes by specialty (2 pediatricians, 3 pediatric allergists, 5 pediatric respirologists). Univariate analyses compared investigation, including allergy testing (skin prick or RAST), comorbid conditions, and prescription by specialty. Multivariate regression, which controlled for random effect of the individual physician, examined specialty differences for prescribed inhaled corticosteroids (ICS) and changes in percentage predicted FEV1.
RESULTS: More than 56% of the patients (309/548) were seen by pediatric respirologists, 26% by pediatric allergists, and 18% by pediatricians. Physician specialty influences investigation requested, comorbid diagnoses, treatment, and improvement in FEV1. Pediatric allergists' patients had more allergy tests, were more likely to be diagnosed with allergic rhinitis and, consequently, were more likely to be prescribed nasal steroids than pediatricians and pediatric respirologists. Pediatricians were less likely to prescribe ICS (odds ratio 0.39 [95% CI, 0.15-0.96]; P < .05) than pediatric allergists, with the greatest difference in ICS prescription among children with a percentage predicted FEV1 ≥ 80%. Improvement in FEV1 among children who received care with pediatric allergists was higher than those seen by pediatricians (13%; P < .001) and pediatric respirologists (8%; P = .005).
CONCLUSIONS: Patient management domains with the greatest room for discretion (investigations, comorbid diagnoses, and treatment with ICS among children with normal lung function) are most heavily influenced by physician specialty. These results have implications for asthma management at the patient level and in future practice guidelines.
 

JAllergyClinImmunolPract.2014May-Jun;2(3):306-312.e5.doi:10.1016/j.jaip.2013.12.005. Epub 2014 Apr 2.