Improving Asthma Management among African-American Children via a Community Health Worker Model: Findings from a Chicago-Based Pilot Intervention
Improving Asthma Management among African-American Children via a Community Health Worker Model: Findings from a Chicago-Based Pilot Intervention
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DOI：
10.3109/02770903.2012.660295
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发表时间：
2012-05-01
影响因子：
1.9
通讯作者：
Whitman, Steven
中科院分区：
文献类型：
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作者：
Margellos-Anast, Helen;Gutierrez, Melissa A.;Whitman, Steven
目标。生活在芝加哥某些弱势社区的儿童中有25-30%患有哮喘，是全国患病率（13%）的两倍。生活在贫困、少数民族社区的儿童往往严重依赖急诊科（ED）进行哮喘治疗，不太可能得到适当的药物治疗或接受哮喘自我管理方面的教育。一个试点项目实施并评估了社区卫生工作者（CHW）模式在降低芝加哥弱势社区非洲裔美国儿童哮喘发病率和改善生活质量方面的有效性。方法。来自目标社区的训练有素的卫生保健员在6个月内进行3至4次家访，提供个性化的哮喘教育。卫生保健员还担当家庭和医疗系统之间的联络人。在2004年11月15日至2005年7月15日期间，70名儿童参加了试点阶段，其中96%参加了医疗补助计划的保险，54%与吸烟者一起生活。在开始之前，该研究得到了机构审查委员会的批准。50名完成整个12个月评估阶段的儿童（71.4%）的数据采用前后研究设计进行分析。结果。结果表明哮喘控制得到改善。具体而言，在干预前后期间，症状频率减少了35%，紧急卫生资源利用率减少了75%。父母的生活质量也得到了一定程度的改善，这在临床上和统计学上都是显著的。其他重要的结果包括改善哮喘相关知识，减少暴露于哮喘诱因，改善医疗管理。干预措施也被证明具有成本效益，估计每花费1美元干预措施可节省5.58美元。结论。研究结果表明，由训练有素、文化上有能力的CHW提供的个体化哮喘教育对改善控制不良的市中心儿童的哮喘管理是有效的。需要进一步的研究来确认这些发现并评估该模型的普遍性。
Objectives. Asthma affects 25-30% of children living in certain disadvantaged Chicago neighborhoods, a rate twice the national prevalence (13%). Children living in poor, minority communities tend to rely heavily on the emergency department (ED) for asthma care and are unlikely to be properly medicated or educated on asthma self-management. A pilot project implemented and evaluated a community health worker (CHW) model for its effectiveness in reducing asthma morbidity and improving the quality of life among African-American children living in disadvantaged Chicago neighborhoods. Methods. Trained CHWs from targeted communities provided individualized asthma education during three to four home visits over 6 months. The CHWs also served as liaisons between families and the medical system. Seventy children were enrolled into the pilot phase between 15 November 2004 and 15 July 2005, of which 96% were insured by Medicaid and 54% lived with a smoker. Prior to starting, the study was approved by an institutional review board. Data on 50 children (71.4%) who completed the entire 12-month evaluation phase were analyzed using a before and after study design. Results. Findings indicate improved asthma control. Specifically, symptom frequency was reduced by 35% and urgent health resource utilization by 75% between the pre- and post-intervention periods. Parental quality of life also improved by a level that was both clinically and statistically significant. Other important outcomes included improved asthma-related knowledge, decreased exposure to asthma triggers, and improved medical management. The intervention was also shown to be cost-effective, resulting in an estimated $5.58 saved per dollar spent on the intervention. Conclusions. Findings suggest that individualized asthma education provided by a trained, culturally competent CHW is effective in improving asthma management among poorly controlled, inner-city children. Further studies are needed to affirm the findings and assess the model's generalizability.