Telemedicine Enhanced Asthma Management - Uniting Providers for Teens (TEAM-UP for Teens)

远程医疗增强哮喘管理 - 联合青少年提供者 (TEAM-UP for Teens)

• 批准号: 10229607
• 负责人: Jill S Halterman
• 金额: $ 88.89万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-05 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10229607
• 关键词: Absenteeism; Adherence; Adolescent; Asthma; Caring; Cessation of life; Child; Clinical; Communities; Consultations; Control Groups; Counseling; Development; Directly Observed Therapy; Drug Prescriptions; Education; Effectiveness; Emergency Situation; Emergency department visit; Ensure; Guideline Adherence; Guidelines; Healthcare; Hospitalization; Hypersensitivity; Inflammation; Infrastructure; Intervention; Low income; Mediator of activation protein; Minority; Modeling; Morbidity - disease rate; Motivation; National Heart, Lung, and Blood Institute; Nurses; Outcome; Persons; Pharmaceutical Preparations; Population; Prevention; Preventive; Preventive care; Preventive therapy; Process; Process Measure; Provider; Public Health; Quality of life; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Regimen; Resources; Risk; Sampling; Schools; Self Management; Site; Specialist; Supervision; Symptoms; System; Technology; Teenagers; Telemedicine; Testing; Time; Urban Health; Visit; Visiting Nurse; Work; age group; base; care outcomes; care providers; comorbidity; compliance behavior; contextual factors; demographics; disparity reduction; effectiveness evaluation; elementary school; experience; follow-up; functional outcomes; high risk; implementation intervention; improved; improved outcome; innovation; intervention effect; medication compliance; motivational enhancement therapy; novel; optimal treatments; patient-clinician communication; primary outcome; programs; randomized trial; response; satisfaction; social factors; telehealth; treatment planning; urban children; virtual healthcare

Low-income, minority teenagers have disproportionately high rates of asthma morbidity, including excess risk of emergency department visits, hospitalizations, and death from asthma. Despite well established guidelines, under-treatment for asthma is common, particularly for poor urban teens. Our prior work has demonstrated that school-based directly observed therapy (DOT) of preventive asthma medications can improve outcomes for young, urban children with persistent asthma. We have also found that school-based telemedicine can effectively facilitate assessments by primary care providers (PCPs) for preventive medication prescriptions for DOT and for follow-up care. We recently conducted a study for teens with persistent asthma which included a trial of DOT of preventive medications at school paired with motivational interviewing (MI) counseling to promote independent adherence. While this program successfully improved medication adherence, it had a limited effect on asthma symptoms, and in particular many of the teens with moderate to severe persistent asthma at baseline continued to experience poor control despite the intervention. This was at least in part because for many of these teens, the medications initially prescribed for DOT were not optimally adjusted by PCPs and their asthma was undertreated. We realize that this program may be insufficient for these teens (>½ of the overall sample), since access to recommended specialist consultation for medication step-up or management of co-morbidities was not included. Further, while education and self-management support are critical for this age group, the MI counseling in this program required resources for several in-person visits. We now aim to test a novel, developmentally appropriate and scalable model of care to ensure optimal guideline- based treatment for urban teens with difficult to control asthma. The Telemedicine Enhanced Asthma Management-Uniting Providers for Teens (TEAM-UP Teens) program includes 3 core components: 1) An optimized asthma management plan developed at the start of the school year via a real-time, synchronous school-based telemedicine visit that directly connects the teen to an asthma specialist, 2) School-based DOT to implement the medication plan and allow for teens to experience the benefits of consistent therapy, 3) Follow-up telehealth visits with a nurse asthma educator to facilitate ongoing care and provide developmentally appropriate self-management support. In response to PA-18-722; Improving Patient Adherence to Treatment and Prevention Regimens, we propose a full-scale randomized trial of TEAM-UP for Teens vs an enhanced care (EC) control group (n=360, 12-16yrs). We will capitalize on the existing community infrastructure by implementing both telemedicine visits and DOT in schools. We will assess the effectiveness of TEAM-UP for Teens in reducing morbidity and improving guideline-based care (primary outcome: symptom-free days at 3, 6, 9, and 12 months) versus EC. At the study's completion, the program will be better defined as a sustainable means to improve care and reduce morbidity for high risk teens with moderate to severe persistent asthma.

低收入，少数青少年的哮喘病态率高，包括多余的风险 急诊室就诊，住院和哮喘死亡。 哮喘的治疗不足是常见的，特别是对于贫穷的城市青少年而言。 基于学校的直接观察到预防哮喘药物的治疗（DOT）可以改善结果 年轻的城市儿童持续哮喘。 有效促进初级保健提供者（PCP）进行投影药物处方的评估 DOT和后续护理。 对学校的预防点审判以及动机访谈（MI）咨询的审判 促进独立的依从性，而该计划成功改善了药物的依从性 对哮喘症状的影响有限，尤其是许多中度至严重的青少年 尽管进行了干预，但基线时哮喘仍会继续受到控制不佳的控制。 因为对于许多这些青少年，最初对DOT进行判断的药物并未通过 我们意识到该程序可能不足这些时态（>½ 在整个样本中），因为访问推荐的药物加入或 未包括合并症的管理。 对这个年龄段的批判性，该计划中的MI咨询需要严重性面对面的访问。 现在，旨在测试一种新颖，开发的适当和可扩展的护理模型，以确保确保最佳准则 - 基于Difficalt的城市青少年控制哮喘。 青少年的管理服务提供商（团队青少年）计划包括3个核心组成部分：1） 通过实时的，同步的，在学校开始制定的优化哮喘管理计划 基于学校的远程医疗访问将青少年直接连接到哮喘专家，2）基于学校的DOT 实施药物计划并允许青少年体验一贯治疗的好处，3） 与护士哮喘教育者进行后续远程医疗访问，以促进Ongilitete ongolite持续护理和审查 适当的自我支持，以响应PA-18-722； 和预防方案，我们建议对青少年的团队进行全面随机试验与增强 护理（EC）对照组（n = 360，12-16岁）。 在学校中实施远程医疗访问和点。 青少年减少病态和改善基于准则的护理（主要结果：3、6、6、6，无症状的天数） 9和12个月）与研究的压缩相比 改善护理护理并减少患有中度至严重持续性哮喘的高风险青少年的病态。