Implementation of Joint Commission International Accreditation Multidisciplinary Childhood Asthma Program Improved Clinical Outcomes and Asthma Treatment Adherence

實施國際醫療評鑑氣喘臨床照護計畫以改善氣喘照護品質相關性研究

楊端青(Tuan-Ching Yang) ； 賴妃珍(Fei-Chen Lai) ； 高竣凱(Jun-Kai Kao) ； 錢建文(Jien-Wen Chien) ； 李明聲(Ming-Sheng Lee) ； 邱漢堯(Han-Yao Chiu) ； 陳俊佑(Chun-Yu Chen) ； 楊文傑(Wen-Chieh Yang) ； 楊瑞成(Rei-Cheng Yang) ； 蔡易晉(Yi-Giien Tsai)

《The Changhua Journal of Medicine》 14卷4期 (2016/12) Pp. 168-178

https://doi.org/10.6501/CJM.1404.003

摘要

Background: Asthma exacerbation is the leading cause of hospitalization in children. Despite the wide availability of asthma treatment guidelines, the quality of care provided to hospitalized asthmatic children remains suboptimal. This study aimed to create a Joint Commission International Accreditation (JCIA) multidisciplinary childhood asthma program and to evaluate the clinical outcomes and asthma treatment adherence. Methods: We developed, implemented, and evaluated the JCIA multidisciplinary childhood asthma program for hospitalized acute asthmatic children. The program was designed to help pediatric asthmatic patients to achieve good control of asthma symptoms and enhance their self-management ability. The core components of the program are the provision of patient-centered medication management services, evidenced-based asthma education and personal asthma action plans. Using a one-group pre- and post-intervention design, the childhood asthma control test (C-ACT) results, adherence to asthma control medications according to the nine-item Hill- Bone compliance questionnaire, peak expiratory flow rate (PEFR), parental asthma knowledge and inhaler technique for corticosteroid inhalation were evaluated over a six-month period. Results: In total, 91 pediatric asthmatic patients were enrolled in the JCIA childhood asthma program. Only 38 (42%) of the enrolled hospitalized asthmatic patients had perfect adherence to asthma control medication according to self-reported data. The group with poor compliance, as indicated by a high Hill-Bone scale score (＞ 9), had persistently lower C-ACT scores during acute exacerbation (16.8 ± 2.9 vs. 18.2 ± 2.1; p ＜ 0.05) and 6 months after hospital discharge (21.2 ± 2.6 vs. 22.6 ± 2.5; p ＜ 0.05). It was notable that the group with high Hill-Bone scale scores also had poor parental asthma knowledge scores at the initial visit (p ＜ 0.05) as compared with the group with normal Hill-Bone scale scores. Significant clinical improvements were noted after implementation of the multidisciplinary childhood asthma program, as evidenced by high C-ACT scores, a higher PEFR, and good asthma control medication compliance as evidenced by lower Hill-Bone scale scores. Program participants exhibited significant improvements in parental asthma knowledge scores (p ＜ 0.05) and inhaled corticosteroid technique scores (p ＜ 0.05). Conclusions: Implementation of the JCIA childhood asthma program significantly improved asthma treatment adherence and clinical outcome in hospitalized asthmatic children.

關鍵字

asthma ； asthma adherence ； asthma exacerbation

並列摘要

研究背景：氣喘是兒童最主要慢性病，急性氣喘發作是造成兒童住院最常見原因。儘管國際氣喘診療指引（GINA）推動，急性氣喘住院照護品質仍不理想。研究目的：本研究主要目的推動國際醫院評鑑（JCI）認證之兒童氣喘臨床照護計畫（CCPC）並評估兒童氣喘藥物順從度與預後。結果：本研究收集91位因氣喘發作，並加入國際醫院評鑑（JCI）認證之兒童氣喘臨床照護計畫住院病童。本研究發現氣喘控制藥物順從度（Hill-Bone Compliance questionnaires）問卷良好只有38（42%）位住院病童。發作急性期比較，氣喘控制藥物順從度問卷不良住院病童組比較氣喘控制藥物順從度問卷良好住院病童組，有較嚴重度氣喘控制問卷（C-ACT）分數（16.8 ± 2.9 vs. 18.2 ± 2.1; p ＜ 0.05），經過六個月出院追蹤比較嚴重度氣喘控制問卷（C-ACT）分數仍然有統計意義（21.2 ± 2.6 vs. 22.6 ± 2.5; p ＜ 0.05）。介入國際醫院評鑑（JCI）認證之兒童氣喘臨床照護計畫，所有住院病童組兒童氣喘藥物順從度與氣喘知識認知與氣喘相關預後包含氣喘控制問卷（C-ACT）分數與尖峰吐氣流量計（PEFR）數值皆有明顯改善。

並列關鍵字

氣喘 ； 氣喘順從度 ； 氣喘發作