Asthma coaching in the pediatric emergency department
Asthma coaching in the pediatric emergency department
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DOI：
10.1197/j.aem.2006.03.565
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发表时间：
2006-08-01
影响因子：
4.4
通讯作者：
Strunk, Robert C.
中科院分区：
文献类型：
--
作者：
Smith, Sharon R.;Jaffe, David M.;Strunk, Robert C.
目的：教练和金钱激励已被用来修改个人的医疗行为与几种慢性疾病，包括哮喘。作者进行了一项随机对照试验，在哮喘急诊科（艾德）就诊期间进行哮喘指导，并通过金钱激励改善初级保健提供者（PCP）的随访。受试者是2-12岁儿童的父母，有医疗补助或没有医疗保险，在ED接受哮喘治疗。主要结局是在索引艾德访视后两周内因哮喘进行经验证的PCP访视。所有的父母都收到了15美元的时间在ED。父母在干预组被告知，他们将获得额外的15美元的货币奖励，如果PCP访问完成。在艾德访视期间，教练与家长进行了对话，并讨论了与儿童的PCP寻求后续护理的重要性和优势。所有的父母都收到了通常的出院指示，包括建议看到PCP在three days.Results：作者招募了92名家长，结果数据为86（42控制，50干预）。两组的人口统计学特征相似。干预组和对照组之间，（22.0%; 95%置信区间[95% CI] = 11.5%-36.0%）和对照组（23.8%; 95% CI = 12.0%-39.4%）组（p = 0.99）.结论：在急性艾德访视期间进行哮喘辅导和对PCP访视的金钱激励相结合的干预似乎并没有增加PCP的随访。
Objectives: Coaching and monetary incentives have been used to modify medical behavior of individuals with several chronic diseases, including asthma. The authors performed a randomized, controlled trial of an intervention combining asthma coaching during an emergency department (ED) visit for asthma, and monetary incentive to improve follow-up with primary care providers (PCP).Methods: Subjects were parents of children 2-12 years of age, with Medicaid or no medical insurance, receiving treatment for asthma in the ED. The primary outcome was a verified PCP visit for asthma within two weeks of the index ED visit. All parents received $15 for their time in the ED. Parents in the intervention group were told that they would receive an additional $15 monetary incentive if a PCP visit was completed. The coach engaged in a dialogue with the parent during the ED visit, and discussed the importance and advantages of seeking follow-up care with the child's PCP. All parents received the usual discharge instructions, including advice to see the PCP within three days.Results: The authors enrolled 92 parents; outcome data were available for 86 (42 controls, 50 intervention). Demographic characteristics were similar in both groups. There was no significant difference in the proportion of patients who had follow-up PCP visits between the intervention (22.0%; 95% confidence interval [95% CI] = 11.5% to 36.0%) and control (23.8%; 95% Cl = 12.0% to 39.4%) groups (p = 0.99).Conclusions: An intervention combining asthma coaching during acute ED visits and a monetary incentive to return for a PCP visit does not appear to increase follow-up with the PCP.