Ambulatory Management of Childhood Asthma Using a Novel Self-management Application
Ambulatory Management of Childhood Asthma Using a Novel Self-management Application
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DOI：
10.1542/peds.2018-1711
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发表时间：
2019-06-01
期刊：
影响因子：
8
通讯作者：
Stone, Bryan L.
中科院分区：
文献类型：
--
作者：
Nkoy, Flory L.;Fassl, Bernhard A.;Stone, Bryan L.
背景和目的：儿科非卧床哮喘控制不佳，降低了生活质量(QOL)，并导致急诊科(ED)和住院。我们评估了电子哮喘追踪器(e-AT)的影响，e-AT是哮喘儿童的自我监测应用程序。方法：前瞻性队列研究与匹配对照。参与者于2014年1月至2015年12月在11家儿科诊所登记，每周使用e-AT，为期1年。分析包括：(1)儿童(生活质量、哮喘控制、中断和缺课天数)和父母(中断和缺勤工作日和满意度)的纵向变化；(2)比较干预前后ED、住院和口服皮质类固醇(OCS)的使用情况；(3)比较使用e-AT和匹配对照组的ED、住院和口服皮质类固醇(OCS)的使用情况。结果：共有327名儿童和家长参加；12个月时，e-AT的依从率为65%。与基线相比，参与者在所有评估时间都显著(P<；.001)提高了生活质量、哮喘控制，并减少了中断和缺课的天数。与干预前1年相比，他们减少了ED和住院率(RR：0.68；95%可信区间[CI]：0.49-0.95)和OCS使用(RR：0.74；95%CI：0.61-0.91)。家长的满意度仍然很高。与匹配的对照组相比，参与者减少了ED和住院(RR：0.41；95%CI：0.22-0.75)和OCS的使用(RR：0.65；95%CI：0.46-0.93)。结论：E-AT的使用导致了高度和持续的自我监测参与，并改善了哮喘预后。这一护理模式的推广具有广泛改善儿童非卧床哮喘护理的潜力。
BACKGROUND AND OBJECTIVES:Pediatric ambulatory asthma control is suboptimal, reducing quality of life (QoL) and causing emergency department (ED) and hospital admissions. We assessed the impact of the electronic-AsthmaTracker (e-AT), a self-monitoring application for children with asthma.METHODS:Prospective cohort study with matched controls. Participants were enrolled January 2014 to December 2015 in 11 pediatric clinics for weekly e-AT use for 1 year. Analyses included: (1) longitudinal changes for the child (QoL, asthma control, and interrupted and missed school days) and parents (interrupted and missed work days and satisfaction), (2) comparing ED and hospital admissions and oral corticosteroid (OCS) use pre- and postintervention, and (3) comparing ED and hospital admissions and OCS use between e-AT users and matched controls.RESULTS:A total of 327 children and parents enrolled; e-AT adherence at 12 months was 65%. Compared with baseline, participants had significantly (P < .001) increased QoL, asthma control, and reduced interrupted and missed school and work days at all assessment times. Compared with 1 year preintervention, they had reduced ED and hospital admissions (rate ratio [RR]: 0.68; 95% confidence interval [CI]: 0.49-0.95) and OCS use (RR: 0.74; 95% CI: 0.61-0.91). Parent satisfaction remained high. Compared with matched controls, participants had reduced ED and hospital admissions (RR: 0.41; 95% CI: 0.22-0.75) and OCS use (RR: 0.65; 95% CI: 0.46-0.93).CONCLUSIONS:e-AT use led to high and sustained participation in self-monitoring and improved asthma outcomes. Dissemination of this care model has potential to broadly improve pediatric ambulatory asthma care.