Improving preventive care in high risk children with asthma: lessons learned.
Improving preventive care in high risk children with asthma: lessons learned.
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改善高风险儿童哮喘的预防保健：学习的教训。
DOI：
10.3109/02770903.2014.892608
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发表时间：
2014-06
期刊：
影响因子：
--
通讯作者：
Bollinger ME
中科院分区：
文献类型：
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作者：
Butz AM;Halterman J;Bellin M;Kub J;Tsoukleris M;Frick KD;Thompson RE;Land C;Bollinger ME
市中心儿童在哮喘急诊（艾德）就诊后接受预防性哮喘护理的比例较低。本研究的目的是测试与注意力控制组（CON）相比，临床医生和护理人员反馈干预（INT）在哮喘艾德访视后改善预防性哮喘护理方面的疗效。入选了持续性哮喘和近期哮喘艾德访视的儿童（N = 300），并随机分为反馈干预组或注意力控制组，随访12个月。所有的孩子都接受了护士的探访。数据来自访谈、儿童唾液可替宁水平和药房记录。采用标准t检验、卡方检验和多元逻辑回归检验，以检验在12个月内报告超过或等于两次初级保健提供者（PCP）哮喘预防保健访视的组间差异。儿童主要是男性，年轻（3-5岁），非裔美国人和医疗补助保险。12个月内的平均艾德访视率较高（2.29次访视）。参加两次或两次以上PCP访视/12个月或有哮喘行动计划（AAP）的组间无差异。在控制哮喘控制、组状态、儿童年龄和哮喘艾德就诊次数的同时，基线时患有AAP的儿童在12个月内参加两次或两次以上PCP就诊的可能性几乎是对照组的两倍。与注意力控制组相比，临床医生和护理人员的反馈干预在增加哮喘预防护理方面并不成功。需要进一步的研究来制定干预措施，以有效地预防经常使用艾德的高风险内城儿童的发病率。
Rates of preventive asthma care after an asthma emergency department (ED) visit are low among inner-city children. The objective of this study was to test the efficacy of a clinician and caregiver feedback intervention (INT) on improving preventive asthma care following an asthma ED visit compared to an attention control group (CON). Children with persistent asthma and recent asthma ED visits (N = 300) were enrolled and randomized into a feedback intervention or an attention control group and followed for 12 months. All children received nurse visits. Data were obtained from interviews, child salivary cotinine levels and pharmacy records. Standard t-test, chi-square and multiple logistic regression tests were used to test for differences between the groups for reporting greater than or equal to two primary care provider (PCP) preventive care visits for asthma over 12 months. Children were primarily male, young (3–5 years), African American and Medicaid insured. Mean ED visits over 12 months was high (2.29 visits). No difference by group was noted for attending two or more PCP visits/12 months or having an asthma action plan (AAP). Children having an AAP at baseline were almost twice as likely to attend two or more PCP visits over 12 months while controlling for asthma control, group status, child age and number of asthma ED visits. A clinician and caregiver feedback intervention was unsuccessful in increasing asthma preventive care compared to an attention control group. Further research is needed to develop interventions to effectively prevent morbidity in high risk inner-city children with frequent ED utilization.