A Patient Advocate and Literacy-Based Treatment of Asthma

患者倡导者和基于扫盲的哮喘治疗

• 批准号: 7935334
• 负责人: ANDREA J. APTER
• 金额: $ 50.77万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7935334
• 关键词: Accident and Emergency department; Accounting; Address; Adherence; Adopted; Adrenal Cortex Hormones; Adult; Advocate; Affect; Anxiety; Area; Asthma; Attention; Attenuated; Authorization documentation; Breathing; Caring; Chronic Disease; Client satisfaction; Clinic; Communication; Communities; Data Collection; Education; Electronics; Enrollment; Ensure; Focus Groups; Funding; Future; Goals; Health; Health Care Reform; Health system; High Prevalence; Hospitalization; Household; Income; Insurance Coverage; Intervention; Intervention Studies; Latino; Lead; Life; Low income; Measures; Mediating; Mediator of activation protein; Medical; Mental Depression; Methods; Minority; Modeling; Monitor; Observational Study; Occupations; Outcome; Participant; Patients; Physicians; Practice Management; Preparation; Preventive; Problem Solving; Procedures; Provider; Pulmonary Function Test/Forced Expiratory Volume 1; Quality of life; Randomized; Randomized Controlled Trials; Reading; Recommendation; Recruitment Activity; Regimen; Research; Schedule; Self Management; Social Environment; Social Workers; Stimulus; Symptoms; Testing; Training; Visit; arm; asthma prevention; base; cancer therapy; clinically significant; comparative effectiveness; comparative efficacy; cost; cost effectiveness; cultural competence; design; effectiveness research; health care model; health disparity; health literacy; high risk; improved; literacy; novel; primary outcome; randomized trial; skills; trial comparing

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05), Comparative Effectiveness Research, and Specific Challenge Topic 05-MD105, Health Literacy. Half of US adults have no more than basic reading and numerical skills; inadequate health literacy is a consequence. It is associated with unsatisfactory patient-provider communication and poor health outcomes in chronic diseases including asthma. We found low numeracy to be associated with prior ED visits and hospitalizations for asthma and determined that numerical skill may attenuate the association of minority status with lower asthma-related quality of life. We propose a Patient Advocate Intervention (PAI) as the most practical immediate but sustainable method of achieving effective health literacy (EHL) (understanding of asthma management and the practice/health system). Adapted from the Patient Navigator of Harold P. Freeman, MD and informed by focus groups of asthma patients, the PAI addresses low literacy, facilitating patient-provider communication surrounding self-management and navigation of the practice and health system to ensure medical recommendations can be accomplished. The PA is a nonprofessional with guidance from a social worker who will assist with and model preparations for a visit with the asthma doctor, attend the visit, and afterwards confirm understanding as well as facilitate scheduling, obtaining insurance coverage, and overcoming other barriers to carrying out medical advice. The primary outcome is electronically-monitored use of inhaled corticosteroids (ICS), the treatment of choice for all but the mildest asthma. ICS use is a marker of successful patient-provider communication. Other outcomes are asthma-related: hospitalizations, ED visits, change in FEV1, and asthma-related quality of life. We hypothesize that the PAI will improve these outcomes by promoting EHL. We will enroll 84 adults with a high prevalence of low numerical skills who are approximately 67% black and 10% Latino with moderate or severe asthma to carry out the following Specific Aims. Specific Aim 1: refine and evaluate the feasibility of PAI and Specific Aim 2: conduct a randomized comparison of PAI with standard asthma education to obtain effect size estimates for ICS adherence and asthma-related outcomes for a future R01 confirmatory randomized trial of the final version of PAI. Exploratory analyses will assess EHL as a mediator, various moderators, and estimate the incremental costs of PAI. This novel project fills several research gaps. It 1) compares and tests an intervention addressing literacy to improve health, one that can easily be incorporated into practice to better patient self-management and preventive care, 2) is a potentially long-lasting intervention which will benefit all patients, especially those with low health literacy, and 3) will potentially improve prevention of asthma exacerbations, reducing the need for ED use. It fulfills ARRA goals by creating or retaining partial or complete funding for 16 area jobs. Half of US adults have no more than basic reading and numerical skills. A consequence is inadequate health literacy, which is associated with unsatisfactory patient-provider communication and poor health outcomes in chronic diseases, including asthma. We have adapted a patient navigator intervention to address asthma in high risk communities as a practical, immediate, and sustainable method of achieving effective health literacy in patients low health literacy. This intervention will lead to improved adherence and asthma control, attenuating health disparities so marked in asthma. It is compared for efficacy and cost-effectiveness with asthma education. We fulfill ARRA goals by creating or retaining partial or complete funding for 16 area jobs.

描述（由申请人提供）：此申请涉及广泛的挑战领域（05），比较有效性研究和特定挑战主题05-MD105，健康素养。我们一半的成年人只有基本的阅读和数值技能；健康素养不足是一个结果。它与包括哮喘在内的慢性疾病中的患者提供沟通不令人满意和健康状况不佳有关。我们发现低计算能力与先前的ED访问和哮喘住院治疗有关，并确定数值可能会使少数群体状况与哮喘相关质量较低的少数群体状况的关联。我们建议患者倡导干预（PAI）作为实现有效健康素养（EHL）（了解哮喘管理和实践/卫生系统）的最实际但可持续的方法。 PAI改编自医学博士Harold P. Freeman的患者导航员，并由哮喘患者的焦点小组告知，PAI解决了较低的识字率，促进了围绕自我管理和实践和卫生系统导航的患者提供的沟通，以确保可以完成医疗建议。 PA是一个非专业的社会工作者的指导，他将协助和模拟与哮喘医生一起访问，参加访问，然后确认理解并促进安排，获得保险范围，并克服其他障碍，并确认进行医疗建议的其他障碍。主要结果是对吸入的皮质类固醇（IC）的电子监护使用，这是除了最轻度哮喘以外的所有人的选择治疗。 ICS使用是成功提供患者沟通的标志。其他结果是与哮喘有关的：住院，ED访问，FEV1的变化以及与哮喘相关的生活质量。我们假设PAI将通过促进EHL改善这些结果。我们将注册84名低数值技能患病率的成年人，他们的黑色大约67％和10％的拉丁裔患有中度或重度哮喘，以执行以下特定目标。具体目的1：完善和评估PAI和特定目标的可行性2：对PAI与标准哮喘教育进行随机比较，以获取ICS依从性和与哮喘相关结果的效果大小估计值，以对PAI的最终版本的未来R01确认随机试验进行效果。探索性分析将评估EHL作为调解人，各种主持人，并估计PAI的增量成本。这个小说项目填补了一些研究空白。 1）比较并测试一种解决识字以改善健康的干预措施，可以轻松地将其纳入实践中以更好地纳入患者的自我管理和预防性护理，2）是一种潜在的长期干预措施，这将使所有患者受益，尤其是患者，尤其是患有低健康素养的患者，3）将有可能改善预防因素，减少ED使用的需求。它通过为16个地区工作创建或保留部分或全部资金来实现ARRA目标。我们一半的成年人只有基本的阅读和数字技能。结果是健康素养不足，这与包括哮喘在内的慢性疾病中的患者提供的沟通不足和健康状况不佳有关。我们已经改编了患者导航器干预措施，以解决高风险群落的哮喘，作为一种实用，直接和可持续的方法，可在患者中实现有效的健康素养。这种干预将导致依从性和哮喘控制的改善，从而减轻哮喘的健康差异。与哮喘教育的功效和成本效益相比，它可以比较。我们通过创建或保留16个地区工作的部分或全部资金来实现ARRA目标。