Written action plan use in inner-city children: is it independently associated with improved asthma outcomes?
Written action plan use in inner-city children: is it independently associated with improved asthma outcomes?
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DOI：
10.1016/j.anai.2011.04.015
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发表时间：
2011-09-01
影响因子：
5.9
通讯作者：
Krieger, James
中科院分区：
文献类型：
--
作者：
Sunshine, Jacob;Song, Lin;Krieger, James
背景：国家哮喘教育和预防计划的指导方针规定，哮喘的多成分自我管理干预应包括书面行动计划(WAP)。然而，WAPS在改善预后方面的具体、独立的作用尚不清楚。目的：衡量前一年使用WAP与哮喘改善结果之间的关联。方法：我们利用西雅图健康之家II(HH-II)随机对照试验的数据进行了一项纵向准实验研究。上一年的行动计划使用量是在HH-II退出时衡量的。如果参与者每天、几乎每天或每周一次使用他的行动计划，他就是WAP用户，如果他不符合这些标准，就是非用户。敏感度分析探索了指定WAP用户的不那么严格的标准。预先指定的结果是哮喘控制从基线到出院前2周的变化，儿童哮喘照顾者生活质量量表评分，以及紧急卫生服务利用。我们使用稳健的线性和Logistic回归来比较不同组的结果。结果：251名患者参与其中：112名WAP用户；139名非WAP用户。调整后，WAP使用者和非使用者之间的结果没有显著差异。在最近使用紧急医疗服务的参与者中，使用WAP的人比不使用WAP的人哮喘控制得更好。将WAP用户标准更改为包括那些简单地拥有行动计划的人，而不考虑使用情况，并不会改变我们的结果。结论：与不使用WAP相比，前一年使用WAP与结果改善无关。还需要更多的研究来评估这种普遍推荐的干预措施的长期、独立的好处。过敏性哮喘免疫。2011；107：207-213。
Background: Guidelines from the National Asthma Education and Prevention Program stipulate that multicomponent self-management interventions for asthma should include a written action plan (WAP). However the specific, independent effect of WAPs in improving outcomes remains unclear.Objective: To measure the association between WAP use during the previous year and improved asthma outcomes.Methods: We conducted a longitudinal quasi-experimental study using data from the Healthy Homes II (HH-II) randomized controlled trial in Seattle, WA. Action plan use during the previous year was measured at exit of HH-II. A participant was a WAP user if he used his action plan every day, almost every day, or once per week, and non-user if he did not meet these criteria. Sensitivity analyses explored less stringent criteria for WAP user designation. Prespecified outcomes were baseline-to-exit changes in asthma control in the previous 2 weeks, Pediatric Asthma Caregiver Quality of Life Scale score, and urgent health services utilization. We used robust linear and logistic regression to compare outcomes across groups.Results: Two hundred fifty-one patients participated: 112 WAP users; 139 non-users. After adjustment, no significant differences in outcomes were observed between WAP users and non-users. Among a subgroup of participants with recent urgent health services utilization, WAP users had better asthma control than non-users. Changing WAP user criteria to include those who simply owned an action plan, irrespective of use, did not alter our results.Conclusion: WAP use during the previous year was not associated with improved outcomes compared with non-use. Additional studies are needed to assess the long-term, independent benefit of this universally recommended intervention. Ann Allergy Asthma Immunol. 2011;107:207-213.