Shariff Ghazali Sazlina, Ping Yein Lee, Ai Theng Cheong, Norita Hussein, Hilary Pinnock, Hani Salim, Su May Liew, Nik Sherina Hanafi, Ahmad Ihsan Abu Bakar, Chiu-Wan Ng, Rizawati Ramli, Azainorsuzila Mohd Ahad, Bee Kiau Ho, Salbiah Mohamed Isa, Richard A Parker, Andrew Stoddart, Yong Kek Pang, Karuthan Chinna, Aziz Sheikh, Ee Ming Khoo
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引用次数: 0
Abstract
Supported self-management reduces asthma-related morbidity and mortality. This paper is on a feasibility study, and observing the change in clinical and cost outcomes of pictorial action plan use is part of assessing feasibility as it will help us decide on outcome measures for a fully powered RCT. We conducted a pre-post feasibility study among adults with physician-diagnosed asthma on inhaled corticosteroids at a public primary-care clinic in Malaysia. We adapted an existing pictorial asthma action plan. The primary outcome was asthma control, assessed at 1, 3 and 6 months. Secondary outcomes included reliever use, controller medication adherence, asthma exacerbations, emergency visits, hospitalisations, days lost from work/daily activities and action plan use. We estimated potential cost savings on asthma-related care following plan use. About 84% (n = 59/70) completed the 6-months follow-up. The proportion achieving good asthma control increased from 18 (30.4%) at baseline to 38 (64.4%) at 6-month follow-up. The proportion of at least one acute exacerbation (3 months: % difference -19.7; 95% CI -34.7 to -3.1; 6 months: % difference -20.3; 95% CI -5.8 to -3.2), one or more emergency visit (1 month: % difference -28.6; 95% CI -41.2 to -15.5; 3 months: % difference -18.0; 95% CI -32.2 to -3.0; 6 months: % difference -20.3; 95% CI -34.9 to -4.6), and one or more asthma admission (1 month: % difference -14.3; 95% CI -25.2 to -5.3; 6 months: % difference -11.9; 95% CI -23.2 to -1.8) improved over time. Estimated savings for the 59 patients at 6-months follow-up and for each patient over the 6 months were RM 15,866.22 (USD3755.36) and RM268.92 (USD63.65), respectively. Supported self-management with a pictorial asthma action plan was associated with an improvement in asthma control and potential cost savings in Malaysian primary-care patients.Trial registration number: ISRCTN87128530; prospectively registered: September 5, 2019, http://www.isrctn.com/ISRCTN87128530 .
支持自我管理可降低与哮喘有关的发病率和死亡率。本文是一项可行性研究,观察使用图解行动计划在临床和成本结果方面的变化是评估可行性的一部分,因为这将有助于我们确定完全有效的 RCT 的结果测量指标。我们在马来西亚的一家公立初级保健诊所对医生诊断为哮喘并正在吸入皮质类固醇的成人进行了一项前后可行性研究。我们对现有的图解哮喘行动计划进行了改编。主要结果是哮喘控制情况,在 1 个月、3 个月和 6 个月时进行评估。次要结果包括缓解剂的使用、控制药物的依从性、哮喘加重、急诊就诊、住院、工作/日常活动损失天数以及行动计划的使用。我们估算了使用行动计划后在哮喘相关护理方面可能节省的成本。约 84% 的患者(n = 59/70)完成了 6 个月的随访。哮喘得到良好控制的比例从基线时的 18 人(30.4%)增加到 6 个月随访时的 38 人(64.4%)。至少出现过一次急性加重的比例(3 个月:3 个月:差异率为 -19.7;95% CI 为 -34.7 至 -3.1;6 个月:差异率为 -20.3;95% CI 为 -3.1:差异率为 -20.3;95% CI -5.8 至 -3.2)、一次或多次急诊就诊(1 个月:差异率为 -28.6;95% CI -5.8 至 -3.2)的比例:1个月:差异百分比-28.6;95% CI -41.2至-15.5;3个月:差异百分比-18.0;95% CI -5.8至-3.2):1个月:差异率-28.6;95% CI -41.2至-15.5;3个月:差异率-18.0;95% CI -32.2至-3.0;6个月:差异率-20.3;95% CI -41.2至-15.53个月:差异率-18.0;95% CI -32.2至-3.0;6个月:差异率-20.3;95% CI -34.9至-4.6),以及一次或多次哮喘入院(1个月:差异率-14.3;95% CI -34.9至-4.6):1个月:差异百分比-14.3;95% CI -25.2至-5.3;6个月:差异百分比-11.9;95% CI -34.9至-4.6):随着时间的推移,差异率为 -11.9;95% CI -23.2 至 -1.8)有所改善。59名患者在6个月随访时和6个月内每位患者的估计节省费用分别为15866.22马币(3755.36美元)和268.92马币(63.65美元)。使用图形化哮喘行动计划支持自我管理与马来西亚初级保健患者的哮喘控制改善和潜在成本节约相关:2019年9月5日,http://www.isrctn.com/ISRCTN87128530 。
期刊介绍:
npj Primary Care Respiratory Medicine is an open access, online-only, multidisciplinary journal dedicated to publishing high-quality research in all areas of the primary care management of respiratory and respiratory-related allergic diseases. Papers published by the journal represent important advances of significance to specialists within the fields of primary care and respiratory medicine. We are particularly interested in receiving papers in relation to the following aspects of respiratory medicine, respiratory-related allergic diseases and tobacco control:
epidemiology
prevention
clinical care
service delivery and organisation of healthcare (including implementation science)
global health.