The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes
The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes
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DOI：
10.1136/thx.2005.043877
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发表时间：
2005-12-01
期刊：
影响因子：
10
通讯作者：
Harrison, BDW
中科院分区：
文献类型：
--
作者：
Smith, JR;Mildenhall, S;Harrison, BDW
背景：通过解决导致不良结果的社会心理因素的干预措施，可能会降低与严重哮喘相关的发病率和死亡率。进行了一项研究，以评估由呼吸专科护士对有不良哮喘结局风险的成年人进行的为期6个月的家庭心理教育干预的有效性。方法：一项实用的随机对照试验对92名在医院或初级保健哮喘诊所登记的成年人进行了研究。所有患者以前都曾住院和/或接受过英国胸科学会第4 - 5步治疗，未能按时参加门诊预约，或被认为对他们商定的管理的其他方面依从性差。到患者家中进行评估，并在适当情况下进行干预。测量的主要结果是症状控制、哮喘特异性生活质量和一般健康状况。结果：在6个月的主要时间点，常规护理组和干预组在平均症状控制、身体功能或心理健康评分方面无显著差异（差异（95% CI）分别为0.35（-1.83至1.13）、3.10（-11.42至17.63）、0.42(-10.22至11.07)）。在长达12个月的时间里，对哮喘特定生活质量的影响很小（例如，在12个月时调整后的差异为0.13 (95% CI 0.02至0.25)），而对一般健康状况的短期影响，反映了在干预强化阶段结束时观察到的自我护理方面的改善，只有在完全调整后的分析中才明显。结论：接受心理监督的护士提供的以家庭为基础的干预可能对生活质量有影响，但总体而言，对有不良哮喘结局风险的成年人的长期益处有限。
Background: Morbidity and mortality associated with severe asthma might be reduced by interventions that address psychosocial factors contributing to adverse outcomes. A study was undertaken to assess the effectiveness of a 6 month home based psychoeducational intervention delivered by a respiratory nurse specialist for adults at risk of adverse asthma outcomes.Methods: A pragmatic randomised controlled trial was performed in 92 adults registered with hospital or primary care asthma clinics. All had previous hospital admissions and/or were on British Thoracic Society step 4 - 5 treatment and had failed to attend clinic appointments or were considered to have poor adherence to other aspects of their agreed management. Patients were visited in their homes for assessment and, where appropriate, intervention. The main outcomes measured were symptom control, asthma specific quality of life, and generic health status.Results: At the 6 month primary time point there were no significant differences between usual care and intervention groups in mean symptom control, physical functioning, or mental health scores ( differences (with 95% CI) - 0.35 (-1.83 to 1.13), 3.10 (-11.42 to 17.63), 0.42 (-10.22 to 11.07), respectively). Small effects on asthma specific quality of life up to 12 months (e. g. adjusted difference at 12 months 0.13 ( 95% CI 0.02 to 0.25)) and short term effects on generic health status, which mirrored improvements in aspects of self-care observed at the end of the intensive phase of the intervention, were apparent only from fully adjusted analyses.Conclusions: A home based intervention provided by a nurse receiving psychological supervision may have effects on quality of life but is overall of limited long term benefit to adults at risk of adverse asthma OUTCOMES.