摘要
目的 评估基于个案管理模式的慢性疾病管理在过敏性哮喘患者中的临床应用效果.方法 回顾性分析2020 年 2 月至 2023 年 2 月北京清华长庚医院呼吸与危重症医学科门诊收治的过敏性哮喘患者.通过跟踪观察个案管理后 1 个月、3 个月、6 个月及 1 年的哮喘症状控制(ACT评分)及肺功能,分析个案管理对哮喘症状控制及肺功能的改善作用.结果 纳入 175 例患者,男 70 例(40%)、女 105 例(60%);年龄(45.58±13.78)岁;合并过敏性鼻炎 139 例(79.4%).个案管理前后肺功能指标第一秒用力呼气容积占预计值百分比(FEV1%pred)、第一秒用力呼气容积(FEV1)、一秒率(FEV1/FVC)、最大呼气中段流量占预计值百分比(MMEF75/25%pred)和呼气峰流速(PEF)分别由 87.09%±18.56%、(2.65±0.88)L、75.09%±11.93%、52.20%(34.70%,69.30%)、(6.65±1.94)L/s升至97.80%±13.81%、(2.96±0.76)L、84.72%±11.18%、69.20%(53.70%,86.90%)、(7.57±1.89)L/s(P均<0.001).ACT评分显示,个案管理 1 年控制良好率 100%,其中完全控制率达到 69.7%.重复测量方差分析显示性别和过敏性鼻炎史对症状控制效果均无影响(F=0.575,P=0.681;F=2.317,P=0.059);年龄组与个案管理时间存在交互作用,≥60 岁患者在个案管理时间 6 个月时,ACT评分低于≤44 岁和 45～59 岁组患者(P均<0.05).吸入药物使用率和使用药物装置正确率在个案管理 1 个月、3 个月、6 个月、1 年时分别为 98.8%、86.8%、68.0%、51.4%和 98.8%、100%、100%、100%.结论 个案管理模式可显著提高患者使用吸入药物的使用率和使用吸入药物装置正确率,提高症状控制率,促进患者肺功能恢复.
Abstract
Objective To evaluate clinical efficacy of chronic disease management based on a case management model in patients with allergic bronchial asthma.Methods Patients with allergic bronchial asthma admitted to the outpatient of Department of Pulmonary and Critical Care Medicine of Beijing Tsinghua Changgung Hospital from February 2020 to February 2023 were retrospectively included.The effect of case management on asthma symptom control and lung function was analyzed by tracking the asthma symptom control(ACT)score and lung function at 1,3,6 and 12 months after case management.Results A total of 175 patients with allergic asthma were included,comprising 70 male(40%)and 105 female(60%),with a mean age of(45.58±13.78)years.Among these patients,139(79.4%)cases were complicated with allergic rhinitis.Pulmonary function parameters,including FEV1%pred,FEV1,FEV1/FVC,MMEF75/25%pred and PEF,were improved significantly from(87.09±18.56)%,(2.65±0.88)L,(75.09±11.93)%,52.20%(34.70%,69.30%),and(6.65±1.94)L/s to(97.80±13.81)%,(2.96±0.76)L,(84.72±11.18)%,69.20%(53.70%,86.90%),and(7.57±1.89)L/s(all P<0.001),respectively.ACT score showed a 100%good control rate after 1-year case management,with a complete control rate of 69.7%.Repeated measures analysis of variance revealed no significant differences in symptom control based on gender or allergic rhinitis history(F=0.575,P=0.681;F=2.317,P=0.059).There was interaction between age group and case management time.At 6-month case management,the ACT score of patients aged≥60 years old was significantly lower than those of patients≤44 years old and 45-59 years old(both P<0.05).The proportion of inhaled drug usage rate and accuracy rate of using inhalation medication devices at 1-,3-,6-and 12-month case management was 98.8%,86.8%,68.0%,51.4%and 98.8%,100%,100%,100%,respectively.Conclusion The case management model can significantly improve both the usage rate and correct usage rate of inhaled medication device,enhance symptom control rate,and promote lung function recovery.
基金项目
国家自然科学基金(81900021)
北京市临床重点专科项目(XKB2022B1002)
北京清华长庚医院研究基金(22021C1002)
北京市医院管理中心"扬帆"计划临床技术创新项目(ZLRK202323)
国家科技期刊平台
NSTL
万方数据