Factors associated with completion of a behavioral intervention for caregivers of urban children with asthma.
Factors associated with completion of a behavioral intervention for caregivers of urban children with asthma.
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DOI：
10.3109/02770903.2012.721435
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发表时间：
2012-11
期刊：
影响因子：
--
通讯作者：
Bollinger ME
中科院分区：
文献类型：
--
作者：
Butz AM;Halterman JS;Bellin M;Kub J;Frick KD;Lewis-Land C;Walker J;Donithan M;Tsoukleris M;Bollinger ME
内城区儿童在急诊科 (ED) 就诊后接受预防性哮喘后续护理的比例较低。我们实施了一种新颖的行为哮喘干预措施，即儿童哮喘警报 (PAAL) 干预措施，以改善最近因哮喘就诊的城市儿童的门诊随访和预防性护理。本文的目的是描述 PAAL 干预并检查与干预完成者和未完成者相关的因素。患有持续性哮喘且经常就诊的儿童 (N = 300) 被纳入一项 PAAL 干预的随机对照试验，其中包括两次家访和一次与儿童初级保健提供者 (PCP) 的便利随访。儿童被归类为干预完成者，即完成了家访和 PCP 访视，而未完成者则完成了至少一次家访，但未完成 PCP 访视。使用独立性卡方检验、方差分析和多元逻辑回归，通过几个社会人口学、健康和护理人员心理变量检查干预完成状态。儿童是非裔美国人 (95%)、有医疗补助保险 (91%) 和年轻人（3-5 岁，56%）。总体而言，71% 随机接受干预的儿童成功完成了所有家庭和 PCP 就诊（完成者）。与完成干预显着相关的因素包括年龄较小（3-5岁：完成者，65.4%；未完成者，34.1%；p < .001）以及基线时在家中制定哮喘行动计划（完成者：40%；未完成者：21%；p = .02）。在逻辑回归模型中，较小的儿童年龄、制定哮喘行动计划和较低的护理人员日常哮喘压力与成功完成干预措施显着相关。大多数哮喘高危儿童的护理人员都成功地参与了这种基于家庭和 PCP 的干预。患有哮喘的大龄儿童和压力较大的儿童的看护者可能需要额外的支持才能完成计划。此外，缺乏哮喘行动计划可能是预防性护理中预先存在障碍的一个标志。
Rates of preventive follow-up asthma care after an acute emergency department (ED) visit are low among inner-city children. We implemented a novel behavioral asthma intervention, Pediatric Asthma Alert (PAAL) intervention, to improve outpatient follow-up and preventive care for urban children with a recent ED visit for asthma. The objective of this article is to describe the PAAL intervention and examine factors associated with intervention completers and noncompleters. Children with persistent asthma and recurrent ED visits (N = 300) were enrolled in a randomized controlled trial of the PAAL intervention that included two home visits and a facilitated follow-up visit with the child’s primary care provider (PCP). Children were categorized as intervention completers, that is, completed home and PCP visits compared with noncompleters, who completed at least one home visit but did not complete the PCP visit. Using chi-square test of independence, analysis of variance, and multiple logistic regression, the intervention completion status was examined by several sociodemographic, health, and caregiver psychological variables. Children were African-American (95%), Medicaid insured (91%), and young (aged 3–5 years, 56%). Overall, 71% of children randomized to the intervention successfully completed all home and PCP visits (completers). Factors significantly associated with completing the intervention included younger age (age 3–5 years: completers, 65.4%; noncompleters, 34.1%; p < .001) and having an asthma action plan in the home at baseline (completers: 40%; noncompleters: 21%; p = .02). In a logistic regression model, younger child age, having an asthma action plan, and lower caregiver daily asthma stress were significantly associated with successful completion of the intervention. The majority of caregivers of high-risk children with asthma were successfully engaged in this home and PCP-based intervention. Caregivers of older children with asthma and those with high stress may need additional support for program completion. Further, the lack of an asthma action plan may be a marker of preexisting barriers to preventive care.
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