儿童哮喘门诊规范化管理的实践

Application of standardized asthma clinic for asthma management in children

目的开展儿童哮喘门诊规范化管理实践并探讨其效果。方法采用方便抽样法,选取2016年12月—2017年2月在上海市某三级甲等儿童医院哮喘门诊就诊的哮喘患儿173例为研究对象,成立哮喘门诊规范化管理团队,干预措施包括流程优化、患儿档案建立、专业评估、规范诊疗、个性化的健康教育和干预措施的实施、示教药物吸入治疗、实时疾病监控、运用信息技术为哮喘患儿提供专业哮喘管理服务。结果干预6个月后,173例患儿的儿童哮喘测试问卷评分由(19.24±3.49)分提升至(24.25±2.47)分;完全控制哮喘的患儿由61.8%上升到78.6%,未控制哮喘的患儿由11%下降至6.4%;生存质量评分由(69.92±13.56)分上升至(76.37±9.44)分;医疗支出由[2 519.04(750.00,3 750.00)]元/半年降低到[1 338.00(643.75,1 718.75)]元/半年,差异均具有统计学意义(P<0.05)。结论哮喘门诊规范化管理能有效提高哮喘患儿及家长的哮喘管理意识、知识和技术,在提高哮喘控制水平和生存质量的同时,降低医疗支出,缓解家庭的经济压力。

Objective To explore the effects of standardized asthma clinic on asthma management in children. Methods Using convenience sampling method,173 asthmatic children were selected in a tertiary hospital in Shanghai from December 2016 to February 2017. Asthma management team was established,and interventions ineluded：optimizing the flow of clinic,establishing patients＇ files,professional assessment,standardized treatment,personalized health education,evidence-based personalized interventions,education on drug inhalation therapy,real-time monitoring of disease,using information technology to provide specialized asthma management services to children. Results After 6 months＇ intervention,the score of childhood asthma control test was improved from 19.24±3.49 to 24.25±2.47. The level of asthma control was improved with the increasing length of intervention;for children with complete control,the percentage was increased from 61.8% to 78.6%,for children without control,it was decreased from 11% to 6.4%. The quality of life was increased from 69.92±13.56 to 76.37±9.44. The medical expenditure was decreased from 2 519 yuan/half year to 1 338 yuan/half year. The differences were statistically significant （P〈0.05）. Conclusion The standardized asthma management clinic can effectively improve the awareness,knowledge and technique of asthma management for children with asthma and their family, h can not only improve the control level and quality of life ,but also reduce medical expenditure and alleviate financial pressure on the family.