目的·探讨基于EMS［环境管理（environment management，E）、用药指导（medicine direction，M）与自我监测（self monitoring，S）］管理模式的延续性护理在学龄前喘息性疾病儿童中的应用效果。方法·选取2019年12月至2020年11月，在上海交通大学医学院附属儿童医院呼吸科收治的67例0~6岁喘息性疾病患儿，按照随机数字表分为观察组33例和对照组34例，其中失访3例，最终每组32例。观察组采用基于EMS管理模式的延续性护理，对照组给予常规护理和出院电话随访。2组患儿出院后1、3、6个月随访评估儿童呼吸和哮喘测试（Test for Respiratory and Asthma Control in Kids，TRACK）结果、喘息复发情况；出院后6个月随访采用支气管哮喘用药依从性评分表（Medication Adherence Report Scale for Asthma，MARS-A）和护理工作满意度调查表评估用药依从性及护理工作满意度。结果·2组患儿人口学特征及临床基线特征差异无统计学意义。重复测量方差分析结果显示，时间、组别、组别×时间的交互作用对TRACK总分的影响均有统计学意义；出院后1、3、6个月，观察组TRACK总分均显著高于对照组（均P=0.000）；2组患儿TRACK总分均随时间推移逐渐上升（P=0.000）。观察组1、3、6个月随访发现喘息复发率分别为25.0%、18.7%、9.4%，均显著低于对照组（分别为50.0%、43.7%、31.3%，均P<0.05）；广义估计方程分析显示组间比较差异有统计学意义（P=0.013），观察组干预效果优于对照组（OR=0.292）。出院后6个月观察组MARS-A得分为（4.519±0.395）分，显著高于对照组［（3.994±0.739）分，P=0.001］。护理工作满意度调查结果显示，观察组显著高于对照组（P=0.000）。患儿MARS-A得分与护理工作满意度呈中度正相关（r=0.389，P=0.001）。结论·基于EMS管理模式的延续性护理可显著提高学龄前喘息性疾病儿童的用药依从性和喘息控制水平，明显降低喘息复发率，以及提高护理工作满意度。
关键词：EMS管理模式
;
延续性护理
;
学龄前儿童
;
喘息性疾病
Abstract
Objective ·To explore the effect of continuous nursing based on EMS [environment management (E), medicine direction (M) and self monitoring (S)] management mode on the preschool children with asthmatic diseases. Methods ·A total of 67 children aged 0 to 6 years with asthmatic diseases admitted to the Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine from December 2019 to November 2020 were selected and divided into observation group (33 cases) and control group (34 cases) according to the random number table method, with 3 cases lost, and finally 32 cases in each group. The observation group received continuous nursing care based on EMS management mode, while the control group received routine care and discharge follow-up through the telephone. The children in the two groups were followed up at 1, 3, and 6 months after discharge to evaluate the results of Test for Respiratory and Asthma Control in Kids (TRACK) and wheezing recurrence; Medication Adherence Report Scale for Asthma (MARS-A) and Nursing Job Satisfaction Questionnaire were used to evaluate medication adherence and nursing job satisfaction 6 months after discharge. Results ·There was no significant difference in demographic characteristics and clinical baseline characteristics between the two groups. Repeated measures analysis of variance showed that effects of time, groups and the interaction of groups×time on the total score of TRACK were statistically significant. The total scores of TRACK in the observation group were significantly higher than those in the control group at 1, 3, and 6 months after discharge (P=0.000). The total scores of TRACK in the two groups gradually increased with time (P=0.000). The recurrence rates of wheezing in the observation group were 25.0%, 18.7%, and 9.4% at 1, 3, and 6 months after discharge, which were significantly lower than those in the control group (50.0%, 43.7%, and 31.3%, respectively, P<0.05). Generalized estimating equation analysis showed that there was a statistically significant difference between the two groups (P=0.013), and the intervention effect of the observation group was better than that of the control group (OR=0.292). The MARS-A score of the observation group was 4.519±0.395 at 6 months after discharge, which was significantly higher than that of the control group (3.994±0.739, P=0.001). The nursing job satisfaction of the observation group was significantly higher than that of the control group (P=0.000). There was a moderate positive correlation between the MARS-A score and the nursing job satisfaction (r=0.389, P=0.001). Conclusion ·Continuous nursing based on EMS management mode can significantly improve the medication compliance and wheezing control level of the preschool children with asthmatic diseases, significantly reduce the recurrence rate of wheezing, and improve the nursing satisfaction.
JIANG Yunli, LI Aiqiu, XIAO Yanshang, LI Tiantian, HU Yachen, ZHANG Xiaoxiao, WU Beirong. Application of continuous nursing based on EMS management mode in preschool children with wheezing diseases. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2024, 44(2): 228-236 doi:10.3969/j.issn.1674-8115.2024.02.009
应用喘息性疾病儿童病例资料表、儿童呼吸和哮喘测试（Test for Respiratory and Asthma Control in Kids，TRACK）评分表、支气管哮喘用药依从性（Medication Adherence Report Scale for Asthma，MARS-A）评分表，以及护理工作满意度调查表对患儿进行评估，建立患儿档案。患儿在住院期间予以常规护理，出院时进行常规指导，包括居家病情观察、用药指导、药物吸入装置使用方法的演示、环境管理、饮食管理、运动建议、心理护理等。推荐患儿家长关注“儿童呼吸之家”微信公众号；该公众号由2名专科护士负责相关健康教育内容推送，包括喘息性疾病危险因素控制与预防措施、喘息发作的识别和紧急处理、居家治疗和护理等科普知识，推送频率为1次/月。出院后1、3、6个月由专科护士进行电话随访和评估，根据随访评估结果给予相应的健康教育措施。
Tab 2 Repeated measures ANOVA of TRACK scores in the two groups at different time points
Time
TRACK score/point
F value
P value
Observation group (n=32)
Control group (n=32)
Before intervention
40.00±24.82
42.03±26.36
0.101
0.752
Follow-up at 1 month
81.09±11.69①
63.44±17.89①
21.842
0.000
Follow-up at 3 months
90.78±5.84①②
76.72±11.26①②
39.345
0.000
Follow-up at 6 months
96.56±3.22①②③
83.91±9.73①②③
48.763
0.000
F value
50.757
35.677
P value
0.000
0.000
Note: As the sphericity assumption was not met, the repeated-measures ANOVA was corrected with Greenhouse-Geissler correction. The interaction between group and time was statistically significant (Ftime×group=6.731, P=0.004), and a simple effect analysis was performed. The effects of group and time were both significant (Fgroup=14.920, P=0.000; Ftime=170.747, P=0.000). ①P=0.000, compared with that before intervention in the same group; ②P=0.000, compared with that follow-up at 1 month in the same group; ③P=0.000, compared with that follow-up at 3 months in the same group. All pairwise comparisons were corrected by Bonferroni correction.
The study was designed by JIANG Yunli and LI Aiqiu. The manuscript was drafted and revised by LI Aiqiu and JIANG Yunli. The data were analyzed by LI Aiqiu and JIANG Yunli. Data collection, case follow-up and study implementation were completed by LI Aiqiu, JIANG Yunli, XIAO Yanshang, LI Tiantian, HU Yachen, ZHANG Xiaoxiao and WU Beirong. All the authors have read the last version of paper and consented for submission.
利益冲突声明
所有作者声明不存在利益冲突。
COMPETING INTERESTS
All authors disclose no relevant conflict of interests.
The Expert Committee on Pediatric Medicine, National Health and Family Planning Commission of The People's Republic of China, Respiratory Group, Pediatric Section of Chinese Medical Association, Committee of Respiratory Disease, Pediatric Society of Chinese Physicians' Association, et al. Guidelines for rational drug use in children with wheezing disorders[J]. Chinese Journal of Applied Clinical Pediatrics, 2018, 33(19): 1460-1472.
Chinese Medical Association, Chinese Medical Journals Publishing House, Chinese Society of General Medicine, et al. Guideline for primary care of bronchial asthma (2018)[J]. Chinese Journal of General Practitioners, 2018, 17(10): 751-762.
STOKES J R, BACHARIER L B. Prevention and treatment of recurrent viral-induced wheezing in the preschool child[J]. Ann Allergy Asthma Immunol, 2020, 125(2): 156-162.
SHEN L L, ZHOU L X. Time trend and age-period-cohort effect of incidence and mortality of asthma in children under 15 years in China, 1990‒2019[J]. Modern Preventive Medicine, 2022, 49(21): 3871-3876.
YIN J, GAO Q, LIU T T, et al. Asthma related death and its risk factors in children[J]. Chinese Journal of Applied Clinical Pediatrics, 2021, 36(6): 447-452.
CHI L, SHAN Y X, ZHU Z W. Role of multidimensional assessment in refractory asthma of children[J]. Chinese Journal of Applied Clinical Pediatrics, 2020, 35(4): 262-267.
WONG G W K, KWON N, HONG J G, et al. Pediatric asthma control in Asia: phase 2 of the Asthma Insights and Reality in Asia-Pacific (AIRIAP 2) survey[J]. Allergy, 2013, 68(4): 524-530.
FU X L, GONG X H, TAN J X, et al. Progress on influencing factors for wheezing diseases among children[J]. Chinese Journal of Child Health Care, 2018, 26(11): 1207-1210.
WANG H M, LIU C H. Long-term prognosis and impact factors of recurrent wheezing in young children[J]. Chinese Journal of Applied Clinical Pediatrics, 2019, 34(12): 957-959.
Asthma Group of Chinese Thoracic Society. Guidelines for bronchial asthma prevent and management (2020 edition)[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2020, 43(12): 1023-1048.
LI A Q, ZHANG X X, JIANG Y L, et al. Risk factors of recurrent wheezing in preschool children[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(10): 1435-1440.
CHEN J, ZHANG X M, LIU S S, et al. Study on the application of continuous nursing led on the theory of interactive standard theory after heart transplantation[J]. Chinese Journal of Practical Nursing, 2022, 38(9): 659-666.
KONG F Y. Effect of case management nursing model based on Omaha system on lung function, self-care ability and quality of life in elderly patients with chronic bronchitis[J]. International Journal of Nursing, 2022, 41(1): 147-150.
WEI J, LIU H, LU H M, et al. Application of continuous nursing based on Siebens domain management model in patients with severe cerebral hemorrhage[J]. Chinese Journal of Modern Nursing, 2021, 27(22): 3055-3059.
FU X L, HE L Q, GONG X H, et al. Influencing factors on the knowledge, attitude and practice of caregivers for asthmatic children[J]. Nursing Journal of Chinese People's Liberation Army, 2018, 35(23): 22-26.
XIE J, ZHANG Y X, FAN J H, et al. Effects of care information system combined with case management in children with hematological malignancies[J]. Chinese Journal of Modern Nursing, 2022, 28(30): 4208-4214.
GROVER C A, SUGHAIR J, STOOPES S, et al. Case management reduces length of stay, charges, and testing in emergency department frequent users[J]. West J Emerg Med, 2018, 19(2): 238-244.
JOO J Y, HUBER D L. Case management effectiveness on health care utilization outcomes: a systematic review of reviews[J]. West J Nurs Res, 2019, 41(1): 111-133.
KAN R X, ZHOU F, WANG J T, et al. Study on the effect of "full chain" information-based health management mode in home care of children with bronchial asthma[J]. Chinese Journal of Practical Nursing, 2021, 37(25): 1974-1978.
The Subspecialty Group of Respiratory Diseases, The Society of Pediatrics, Chinese Medical Association, The Editorial Board, Chinese Journal of Pediatrics. Guideline for the diagnosis and optimal management of asthma in children (2016)[J]. Chinese Journal of Pediatrics, 2016, 54(3): 167-181.
WANG X J, LIN R J. Comparison between modified Chinese Version of Test for Respiratory and Asthma Control in Kids and Global Initiative for Asthma guideline[J]. Chinese Journal of Applied Clinical Pediatrics, 2019, 34(16): 1223-1226.
HONG J G. Modified Chinese version of the Test for Respiratory and Asthma Control in Kids (TRACK) and its clinical value[J]. Chinese Journal of Practical Pediatrics, 2018, 33(3): 192-195.
Academic Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Doctor Association, the Editorial Board, Chinese Journal of Pediatrics, Committee on Respiratory Diseases, Fu Tang Research Center of Pediatric Development. Clinical practice expert consensus on differential diagnosis and initial management of wheezing in children under 6 years of age[J]. Chinese Journal of Pediatrics, 2023, 61(4): 301-309.
WANG Y, SUN A X, TERIGELE, et al. Evaluation of the skill, adherence and effectiveness of medication in asthma patients from a pharmacist perspective[J]. China Pharmacy, 2022, 33(13): 1642-1646, 1659.
CHAN A H Y, HORNE R, HANKINS M, et al. The Medication Adherence Report Scale: a measurement tool for eliciting patients' reports of nonadherence[J]. Br J Clin Pharmacol, 2020, 86(7): 1281-1288.
TIAN Q X, YU L J. Reliability and validity of the Chinese version of Medication Adherence Report Scale for Asthma[J]. Chinese Journal of Nursing, 2014, 49(5): 621-624.
LI A Q, CHEN L J, LU Q F, et al. Analysis of knowledge and awareness of home atomization for children with asthmatic diseases[J]. Chinese Journal for Clinicians, 2017, 45(11): 98-100.
HONG L M. Effects of chronic disease nursing management on disease knowledge, treatment compliance and quality of life in patients with nephrotic syndrome[J]. International Journal of Nursing, 2022, 41(4): 705-708.
WANG X G, WANG J, QU W G, et al. Analysis of the knowledge awareness rate of parents, drug compliance and influencing factors of asthmatic children[J]. Progress in Modern Biomedicine, 2019, 19(17): 3271-3274.
LI N, ZHANG T. Effects of family education-environment improvement transitional care on compliance, quality of life, and relapse rate of children with asthma[J]. International Journal of Nursing, 2021, 40(24): 4593-4596.
LI X X, DONG L M, LIU X Y, et al. To explore the influencing factors of treatment compliance of asthma patients based on structural equation modeling[J]. Chinese Journal of Disease Control and Prevention, 2017, 21(2): 187-191.
ZHU W Y, ZHANG Q C, ZHOU Y H, et al. Effect of individual case management of COPD patients in respiratory nursing outpatient department[J]. Chinese Journal of Health Management, 2022, 16(2): 95-98.
TIAN J L, ZHANG S, WANG W. Current status and prospects of the management models for chronic respiratory disease[J]. Chinese Journal of Modern Nursing, 2019, 25(14): 1717-1720.
CUI H X, GE B, ZHAO J W, et al. Effects of specialized nursing team model in children with severe asthma[J]. Chinese Journal of Modern Nursing, 2021, 27(4): 480-484.
