ADHERENCE INTERVENTION FOR MINORITY CHILDREN WITH ASTHMA

对患有哮喘的少数民族儿童的依从性干预

• 批准号: 6638567
• 负责人: CYNTHIA S RAND
• 金额: $ 41.73万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-04-01 至 2006-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6638567
• 关键词: African American; Medicare /Medicaid; asthma; behavioral /social science research tag; clinical research; depression; emergency care; family structure /dynamics; functional ability; health care service utilization; health education; human subject; longitudinal human study; low socioeconomic status; middle childhood (6-11); patient care management; preschool child (1-5); quality of life; respiratory disorder chemotherapy; therapy compliance

Low-income, minority children have disproportionately high rates of emergency department (ED) care for asthma compared to other children. Lack of access to asthma primary care and under-treatment of asthma have been implicated as contributing factors to this excess morbidity. Preliminary research by this group suggests that poor adherence with prescribed asthma therapies may also play a significant role. In a pilot study of low-income, minority children with symptomatic asthma we observed average daily adherence with anti-inflammatory therapy ranging from 1 percent to 32 percent of prescribed use. We hypothesize that improved adherence with asthma therapy can significantly reduce emergency room use for asthma care among high-risk children. To test this hypothesis, we will evaluate the effectiveness of an intensive adherence intervention that utilizes electronic medication monitors and medication measurement for monitoring and feedback, compared to a home-based asthma education intervention, and a usual care control group. The Johns Hopkins Pediatric Emergency Department (JHPED) will serve as our recruitment site. Families of asthmatic children ages 2-12 (N=270) with two or more emergency room visits or a hospitalization for asthma care in the past 12 months will be enrolled. Baseline measures will be collected after obtaining consent and prior to randomization. Participants will be randomly assigned to: 1) an Asthma Basic Care Intervention, or 2) an Adherence Monitoring and Feedback Intervention, or 3) a Usual Care Control Group. The duration of each intervention will be three months, with two booster visits at 6 months. Follow-up measures will be collected from families at 6, 12, and 18 months. The primary outcome measure will be medical record documented emergency care for asthma at the JHPED or other emergency or urgent care facilities over the eighteen-month follow-up period. Secondary outcomes include adherence with asthma therapy based on Medicaid pharmacy claims for asthma medications, other asthma health care (urgent and primary), self-reported medication adherence, barriers to health care, school absences, restricted activity, nighttime symptoms, asthma medications, self and family asthma management, asthma management self-efficacy, functional status, and quality of life.

与其他儿童相比，低收入的少数民族儿童对哮喘的急诊科（ED）护理率不成比例。 缺乏获得哮喘初级保健和哮喘治疗不足的机会被认为是导致这种过度发病率的因素。 该小组的初步研究表明，对处方哮喘疗法的依从性差也可能发挥重要作用。 在一项低收入的试点研究中，有症状性哮喘的少数族裔儿童观察到平均每日依从性，抗炎疗法的平均依从性范围从处方使用的1％到32％。 我们假设改善哮喘治疗的依从性可以大大减少高危儿童哮喘护理的急诊室使用。 为了检验这一假设，与基于家庭的基于家庭的哮喘教育干预措施相比，我们将评估使用电子药物监测器和药物测量的密集依从性干预措施的有效性，并进行监测和反馈。约翰·霍普金斯儿科急诊室（JHPED）将作为我们的招聘场所。 在过去的12个月中，哮喘儿童的2-12岁儿童（n = 270），有两次或更多急诊室就诊或住院治疗。 在获得同意书后和随机分组之前，将收集基线度量。 参与者将被随机分配给：1）哮喘基础护理干预措施，或2）依从性监测和反馈干预措施，或3）通常的护理控制组。 每次干预的持续时间为三个月，在6个月时进行了两次助推器访问。 将在6、12和18个月的家庭中收集随访措施。主要结果措施将是在18个月的随访期间，病历记录在JHPED或其他紧急或紧急护理机构的哮喘的急诊护理。次要结果包括基于医疗补助药房对哮喘药物，其他哮喘医疗保健（紧急和初级），自我报告的药物依从性，卫生保健障碍，学校缺席，受限夜间活动，夜间症状，哮喘药物，自我和家庭哮喘管理，哮喘管理，哮喘管理自我效能，职能效果，身体和良好的生活，遵守哮喘的障碍，诊断障碍，夜间症状，夜间症状，诊断症状，自我报告症状，自我报告症状，自我报告的障碍。

项目成果

Improving patient adherence with asthma self-management practices: what works?

• DOI: 10.1016/j.anai.2012.06.009
• 发表时间: 2012-08-01
• 期刊: ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY
• 影响因子: 5.9
• 作者: Eakin, Michelle N.;Rand, Cynthia S.
• 通讯作者: Rand, Cynthia S.

Prospective relationship between maternal depressive symptoms and asthma morbidity among inner-city African American children.

内城区非裔美国儿童母亲抑郁症状与哮喘发病率之间的前瞻性关系。

• DOI: 10.1093/jpepsy/jsp091
• 发表时间: 2010
• 期刊: Journal of pediatric psychology
• 影响因子: 3.6
• 作者: Otsuki,Michiko;Eakin,MichelleN;Arceneaux,LisaL;Rand,CynthiaS;Butz,ArleneM;Riekert,KristinA
• 通讯作者: Riekert,KristinA