Partner randomized controlled trial: study protocol and coaching intervention
Partner randomized controlled trial: study protocol and coaching intervention
复制标题
DOI：
10.1186/1471-2431-12-42
复制
发表时间：
2012-04-02
期刊：
影响因子：
2.4
通讯作者：
Strunk, Robert C.
中科院分区：
文献类型：
--
作者：
Garbutt, Jane M.;Highstein, Gabrielle;Strunk, Robert C.
背景：许多哮喘儿童生活在频繁的症状和活动限制，紧急护理的访问是常见的。许多儿科医生没有定期与家庭会面，以监测哮喘控制，确定管理方面的问题或问题，或提供自我管理教育。改善哮喘护理的有效干预措施，如小组培训和护理重新设计，很难传播到办公室实践中。方法和设计：本文描述了一项随机对照试验（RCT）的方案，以评估一项为期12个月的电话指导计划，该计划旨在支持持续性哮喘儿童的初级保健管理，并随后改善哮喘控制和疾病控制。相关的生活质量和减少哮喘护理的紧急护理事件。随机化发生在实践层面，符合条件的家庭在实践中有机会获得教练计划或常规护理。教练干预是基于行为改变的跨理论模型。目标行为包括1）有效使用控制药物，2）有效使用急救药物，3）监测以确保最佳控制。受过培训的非专业教练为家长提供哮喘护理的教育和支持，根据家长改变孩子日常哮喘管理的准备情况定制所提供的信息和联系频率。辅导电话的频率从每周到每月不等。对于每个参与的家庭，在入组研究后12个月和24个月通过电话访谈获得随访测量结果，主要结果是1）儿童哮喘控制评分，2）父母生活质量评分和3）12个月和24个月评估的紧急护理事件数量的平均变化。次要结果反映了初级保健儿科医生对指南建议的遵守情况，包括儿童处方控制药物的比例，每年至少两次的维护护理访视和哮喘行动计划。成本效益的干预措施也measured.Discussion：22个做法（66名医生）进行了随机化（11个治疗组），950个家庭与一个孩子3-12岁的持续性哮喘。介绍了教练干预的描述。
Background: Many children with asthma live with frequent symptoms and activity limitations, and visits for urgent care are common. Many pediatricians do not regularly meet with families to monitor asthma control, identify concerns or problems with management, or provide self-management education. Effective interventions to improve asthma care such as small group training and care redesign have been difficult to disseminate into office practice.Methods and design: This paper describes the protocol for a randomized controlled trial (RCT) to evaluate a 12-month telephone-coaching program designed to support primary care management of children with persistent asthma and subsequently to improve asthma control and disease-related quality of life and reduce urgent care events for asthma care. Randomization occurred at the practice level with eligible families within a practice having access to the coaching program or to usual care. The coaching intervention was based on the transtheoretical model of behavior change. Targeted behaviors included 1) effective use of controller medications, 2) effective use of rescue medications and 3) monitoring to ensure optimal control. Trained lay coaches provided parents with education and support for asthma care, tailoring the information provided and frequency of contact to the parent's readiness to change their child's day-to-day asthma management. Coaching calls varied in frequency from weekly to monthly. For each participating family, follow-up measurements were obtained at 12- and 24-months after enrollment in the study during a telephone interview.The primary outcomes were the mean change in 1) the child's asthma control score, 2) the parent's quality of life score, and 3) the number of urgent care events assessed at 12 and 24 months. Secondary outcomes reflected adherence to guideline recommendations by the primary care pediatricians and included the proportion of children prescribed controller medications, having maintenance care visits at least twice a year, and an asthma action plan. Cost-effectiveness of the intervention was also measured.Discussion: Twenty-two practices (66 physicians) were randomized (11 per treatment group), and 950 families with a child 3-12 years old with persistent asthma were enrolled. A description of the coaching intervention is presented.