哮喘联盟

   摘要
   研究背景：哮喘急性发作是患者向救护车寻求救护的常见原因之一。尽管对哮喘急性发作的患者进行更好的护理能够预防可避免的发病与死亡，但却少有研究涉及救护车上医护人员对国家哮喘评估与治疗指南的遵守程度，也未探究如何改善这一情况。本研究旨在通过探索医护人员对哮喘入院前管理的态度、观念及相信程度，从而发现遵守指南的障碍和助力。
   研究方法：在英国救护车区域，对三组特定医护人员进行采访研究，所得数据通过NVivo 8软件进行录入和分析。
   研究结果：对来自三个地区，包括医护人员、高级医护人员或医护业务经理在内的十七名参与者进行采访调查。通过采访得出五个结论：（1）指南应与救护车救护服务有更强的关联性；（2）救护车上进行疾病评估存在困难；（3）患者与医护人员的预期常有冲突，亟待解决；（4）救护车救护服务的复杂流程及众多设备应被纳入考量；（5）最后，就哮喘而言，救护车救护服务有机会做到更好的入院前宣教、疾病信息普及、医患沟通以及支持治疗。
   结论：这项定性研究深入探索了医护人员对哮喘评估与治疗的观念，以及其未能遵守相关指南的原因。这些发现为加强临床支持、患者沟通、专业人员间信息转化及哮喘患者入院前护理提供了机会。
 

（苏楠 审校）
BMC Emerg Med. 2014 Aug 3;14(1):18.

 

Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study.
 

Shaw D1, Siriwardena AN.
 

ABSTRACT
BACKGROUND: Acute asthma is a common reason for patients to seek care from ambulance services. Although better care of acute asthma can prevent avoidable morbidity and deaths, there has been little research into ambulance clinicians' adherence to national guidelines for asthma assessment and management and how this might be improved. Our research aim was to explore paramedics' attitudes, perceptions and beliefs about prehospital management of asthma, to identify barriers and facilitators to guideline adherence.
METHODS: We conducted three focus group interviews of paramedics in a regional UK ambulance trust. We used framework analysis supported by NVivo 8 to code and analyse the data.
RESULTS: Seventeen participants, including paramedics, advanced paramedics or paramedic operational managers at three geographical sites, contributed to the interviews. Analysis led to five themes: (1) guidelines should be made more relevant to ambulance service care; (2) there were barriers to assessment; (3) the approach needed to address conflicts between clinicians' and patients' expectations; (4) the complexity of ambulance service processes and equipment needed to be taken into account; (5) and finally there were opportunities for improved prehospital education, information, communication, support and care pathways for asthma.
CONCLUSIONS: This qualitative study provides insight into paramedics' perceptions of the assessment and management of asthma, including why paramedics may not always follow guidelines for assessment or management of asthma. These findings provide opportunities to strengthen clinical support, patient communication, information transfer between professionals and pathways for prehospital care of patients with asthma.
 

BMC Emerg Med. 2014 Aug 3;14(1):18.