Primary care based clinics for asthma

 

Abstract

Background

Primary care clinics for asthma have been encouraged and are becoming widespread in some countries, particularly in the UK.

Objectives

To determine the effectiveness of organised asthma care via primary care based asthma clinics.

Search methods

A search of the Cochrane Airways Group register and Cochrane Controlled Trials Register using the following search strategy: clinic* OR general pract* OR family pract* or primary care. Separate and additional searches were also conducted using MEDLINE, CINAHL and EMBASE databases.

Selection criteria

Trials had to be performed in primary care and be restricted to patients with asthma. Care could be delivered by doctor or nurse. Two reviewers independently ascertained the relevance of trials from titles and abstracts obtained from the searches. Relevant full text articles were retrieved with two reviewers assessing each study for inclusion.

Data collection and analysis

Two reviewers independently conducted all data abstraction and analysis and all disagreements were resolved by discussion. For the dichotomous variables, odds ratio (OR) or relative risks (RR) with 95% Confidence Interval (95%CI) were calculated for individual outcomes.

Main results

Only one trial met the criteria for inclusion in the review. This trial provided 11 outcome measures of which two showed a significant effect of the intervention. More patients in the intervention group had peak flow meters (RR 1.30; 95%CI 1.05,1.61) and fewer patients in the intervention group were likely to wake up at nights due to their asthma (RR 0.30; 95%CI 0.16, 0.81).

Authors' conclusions

There is limited evidence of benefit for primary care based asthma clinics, but firm conclusions cannot be formed until more good quality trials have been carried out.

 

Plain language summary

Primary care based clinics for asthma

It is not known whether primary care based asthma clinics are effective and what patients' views are on such clinics. A review of all published randomised controlled trials was undertaken assessing the effectiveness of such clinics. There is limited evidence from one study that has assessed the effectiveness of asthma clinics. This study shows that asthma clinics based in primary care can increase the provision of peak flow meters and reduce the number of patients who wake at night due to asthma. We believe that there is a need for further trials in order to assess the effectiveness of asthma clinics.

 

摘要

背景

基層診所的氣喘的處置

基層診所處置氣喘病患已被鼓勵，且在某些國家特別是英國目前變得頗為普及。

目標

確認經由基層診所氣喘門診執行的組織性氣喘照護之效益。

搜尋策略

使用以下策略來搜尋Cochrane Airways Group Register及Cochrane Controlled Trials Register ：“clinic”或“general pract”或“family pract”或“primary care”。其他附加搜尋的尚包括MEDLINE、CLNAHL及EMBASE等資料庫。

選擇標準

試驗必須由基層照護所執行且限制於氣喘病人。照護可由醫師或護士執行。兩位審查者以搜尋得來的文章之題目及摘要獨立地確認是否為相關之試驗。兩位審查者取出相關文章的全文以評估該研究是否要納入分析

資料收集與分析

兩位審查者獨立地執行數據摘取及分析，所有不同的看法均以討論來解決。對於dichotomous變異數，勝算比(OR)或相對風險(RR)及95%信賴區間(95%CI)來計算個別的結果。

主要結論

只有一項試驗符合回顧之納入標準，此試驗提供11個結果測量值，其他2項呈現介入措施具有有意義的效果。在接受介入措施的組別中有較多的病人在頂?氣流計(RR 1.30; 95%CI 1.05, 1.61)及較少數的病人因氣喘而半夜醒來(RR 0.30; 95%CI 0.16, 0.81)

作者結論

有限的證據顯示基層氣喘照護門診的效益，但在有較佳品質的試驗被完成之前仍無法有具體結論。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

基層氣喘照護門診(通常由護士主導而醫師作專業支持)對氣喘患者可能會有幫助，但卻缺少強有力的證據。目前仍未知道基層氣喘照護門診是否具有效益以及病人對這樣的診所觀點如何。本回顧是針對所有已被刊登的隨機對照試驗來評估這類診所的效益。 只有一項研究評估氣喘門診的效益，但所提供的證據有限。此項研究顯示，基層診療提供的氣喘照護可增加頂?氣流量及減少患者夜間因氣喘發作而醒來。我們相信需要有更多的試驗來評估氣喘門診的效益。