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首页> 外文期刊>International journal of nursing studies >Patient, practice and organisational influences on asthma control: Observational data from a national study on primary care in the United Kingdom
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Patient, practice and organisational influences on asthma control: Observational data from a national study on primary care in the United Kingdom

机译：病人，实践和组织对哮喘控制的影响：英国一项全国初级保健研究的观察数据

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Background: Achieving asthma control is central to optimising patient quality of life and clinical outcome. Contemporary models of chronic disease management across a variety of countries point to the importance of micro, meso and macro level influences on patient care and outcome. However, asthma outcomes research has almost invariably concentrated on identifying and addressing patient predictors. Little is known about higher level organisational influences. Objective: This paper explores the contribution of organisational factors on poor asthma control, allowing for patient factors, at three organisational levels: the individual patient, local service deliverers, and strategic regional providers. Design, setting and participants: Prospective cross-sectional observational cohort study of 64,929 people with asthma from 1205 primary care practices spread throughout the United Kingdom (UK). Patient clinical data were recorded during a routine asthma review. Method: Data were analysed using simple descriptive, multiple regression and complex multi-level modelling techniques, accounting for practice clustering of patients. Results: Poor asthma control was associated with areas of higher deprivation [regression coefficient 0.026 (95% confidence intervals 0.006; 0.046)] and urban practice [-0.155 (-0.275; -0.035)] but not all local and regional variation was explained by the data. In contrast, patient level predictors of poor control were: short acting bronchodilator overuse [2.129 (2.091; 2.164)], days-off due to asthma [1.203 (1.148; 1.258)], PEFR. <. 80 [0.76 (0.666; 0.854)], non-use of a self-management plan (SMP) [0.554 (0.515; 0.593)], poor inhaler technique [0.53 (0.475; 0.585)], poor medication compliance [0.385 (-0.007; 0.777)], and gender [0.314 (0.281; 0.347)]. Pattern of medication use, smoking history, age, body mass index (BMI), and health service resource use were also significant factors for predicting control. Conclusions: Targeting of health service resource requires knowledge of the factors associated with poor control of asthma symptoms. In the UK the contribution of local and regional structures appears minimal in explaining variation in asthma outcomes. However, unexplained variation in the data suggests other unrecorded factors may play a part. While patient personal characteristics (including self-management plan use, inhaler technique, medication compliance) appear to be the predominant influence the complex nature of the disease means that some, perhaps more subtle, influences are affecting the variability at all levels and this variance needs to be explored. Further research in other international contexts is required to identify the likely applicability of these findings to other health care systems.
机译：背景：实现哮喘控制对于优化患者的生活质量和临床结果至关重要。在许多国家，慢性病管理的当代模型指出，微观，中观和宏观层面的影响对患者护理和结果的重要性。但是，哮喘结果研究几乎总是集中在识别和解决患者预测因素上。对于高层组织的影响知之甚少。目的：本文探讨组织因素对哮喘控制不佳的影响，并从三个组织层面考虑患者因素：个人患者，本地服务提供者和战略性区域提供者。设计，设置和参与者：前瞻性横断面观察队列研究，研究对象是来自1205种初级保健实践的64929名哮喘患者，分布在英国（英国）。在常规哮喘检查期间记录患者的临床数据。方法：采用简单的描述性，多元回归和复杂的多级建模技术对数据进行分析，以考虑患者的实践聚类情况。结果：哮喘控制不良与贫困程度较高的地区[回归系数0.026（95％置信区间0.006; 0.046）]和城市实践[-0.155（-0.275; -0.035）]有关，但并非所有局部和区域差异均由数据。相反，患者水平控制不佳的预测指标是：短效支气管扩张剂过度使用[2.129（2.091; 2.164）]，因哮喘而休假[1.203（1.148; 1.258）]，PEFR。 <。 80 [0.76（0.666; 0.854）]，未使用自我管理计划（SMP）[0.554（0.515; 0.593）]，吸入器技术不良[0.53（0.475; 0.585）]，药物依从性不良[0.385（- 0.007; 0.777）]和性别[0.314（0.281; 0.347）]。药物使用方式，吸烟史，年龄，体重指数（BMI）和卫生服务资源使用也是预测控制的重要因素。结论：确定医疗服务资源需要了解与哮喘症状控制不良相关的因素。在英国，局部和区域结构的贡献似乎不足以解释哮喘预后的变化。但是，数据的无法解释的变化表明其他未记录的因素可能也起作用。尽管患者的个人特征（包括自我管理计划的使用，吸入器技术，药物依从性）似乎是主要的影响因素，但疾病的复杂性意味着某些（也许更微妙的）影响因素会影响各个级别的变异性，而这种差异性需求有待探索。需要在其他国际环境中进行进一步研究，以确定这些发现可能适用于其他医疗保健系统。

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