Abstract

Objective

Self-management is important for asthma control. We examined associations of patient- and healthcare-related factors with self-reported knowledge of self-management of worsening asthma.

Methods

Two asthma patient cohorts from 2012 (n = 527) and 2015 (n = 915) were randomly selected from 54 primary health care centers (PHCC) in central Sweden. Data were collected using patient questionnaires and questionnaires to the PHCCs. Logistic regression analyzed associations of relevant variables with knowledge of self-management of worsening asthma.

Results

In total, 63% of patients reported moderate to complete knowledge of self-management procedures. The adjusted OR for moderate to complete knowledge relative to high education level was 1.38 [95% CI 1.03–1.85)]; for physician continuity 2.19 (95% CI 1.62–2.96); for a written action plan 11.9 (95% CI 6.16–22.9); for Step 2 maintenance treatment 1.53 (95% CI 0.04–2.24); and 2.07 (95% CI 1.44–2.99) for Step 3. An asthma/COPD nurse visit within the previous 12 months was associated with greater knowledge in women but not in men (p for interaction = 0.042). Smoking [OR 0.56 (95% CI 0.34–0.95)], co-morbidities ≥1 [OR 0.68 (95% CI 0.49–0.93)], and self-rated moderate/severe disease [OR 0.68 (95% CI 0.51–0.90)] were associated with low self-management knowledge.

Conclusion

Self-reported knowledge of self-management procedures was associated with a higher educational level, physician continuity, a written action plan, advanced treatment and, in women, visiting an asthma/COPD nurse. The results reinforce the importance of implementing guidelines of patient access to a specific physician, a written action plan, and structured education by an asthma/COPD nurse.

中文翻译：

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与初级保健患者哮喘恶化自我管理知识相关的因素：一项横断面研究

摘要

客观的

自我管理对于哮喘控制很重要。我们检查了患者和医疗保健相关因素与哮喘恶化自我管理的自我报告知识之间的关联。

方法

从 瑞典中部的 54 个初级卫生保健中心 (PHCC) 中随机选择了2012 年 ( n  = 527) 和 2015 年 ( n = 915) 的两个哮喘患者队列。使用患者问卷和 PHCC 问卷收集数据。Logistic 回归分析了相关变量与哮喘恶化自我管理知识的关联。

结果

总共有 63% 的患者报告对自我管理程序有中度至完全的了解。相对于高等教育水平，中等至完整知识的调整 OR 为 1.38 [95% CI 1.03–1.85)]；医生连续性 2.19 (95% CI 1.62–2.96)；书面行动计划 11.9 (95% CI 6.16–22.9)；第 2 步维持治疗为 1.53（95% CI 0.04–2.24）；步骤 3 为 2.07（95% CI 1.44–2.99）。在过去 12 个月内，哮喘/COPD 护士访问与女性有更多的知识相关，但在男性中没有（交互 p = 0.042）。吸烟 [OR 0.56 (95% CI 0.34–0.95)]，合并症≥1 [OR 0.68 (95% CI 0.49–0.93)]，自评中度/重度疾病 [OR 0.68 (95% CI 0.51–0.90)] )] 与低自我管理知识有关。

结论

自我报告的自我管理程序知识与较高的教育水平、医生的连续性、书面行动计划、先进的治疗以及女性访问哮喘/COPD 护士有关。结果强调了实施患者就医指南、书面行动计划和由哮喘/慢性阻塞性肺病护士进行结构化教育的重要性。