Influence of Caregiver and Provider Communication on Symptom Days and Medication Use for Inner-City Children With Asthma
Influence of Caregiver and Provider Communication on Symptom Days and Medication Use for Inner-City Children With Asthma
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DOI：
10.3109/02770901003692793
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发表时间：
2010-05-01
影响因子：
1.9
通讯作者：
Bollinger, Mary Elizabeth
中科院分区：
文献类型：
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作者：
Butz, Arlene;Kub, Joan;Bollinger, Mary Elizabeth
背景有效的基于儿科指南的哮喘护理要求护理者准确地将儿童的症状频率、急救和控制药物使用的模式以及哮喘控制水平传达给儿童的初级保健医生。Objective.本研究评价了与哮喘教育对照组（CON）相比，社区医生-临床医生哮喘沟通教育干预（ACE）对市中心哮喘儿童症状天数和控制药物使用的纵向影响。参与者和方法。从城市儿科急诊科（ED）和社区实践中招募了231名市中心哮喘儿童，随访12个月。数据包括12个月内出现症状的天数和天数、艾德就诊次数、住院次数、活动受限情况和控制性药物使用情况。药房记录用于计算控制哮喘药物与总哮喘药物的比例，作为适当控制药物使用的代表。在12个月的随访中，使用多变量逻辑回归模型来确定与过去30天内症状日数和夜间数相关的因素。结果大多数照顾者认为与孩子的临床医生的沟通很高。在随访时，各组之间未校正和校正的症状日和夜发生率没有差异。与CON儿童相比，ACE儿童在12个月时倾向于更高的控制者与总药物比率（平均比率：ACE：0.54，SD 0.3; CON，0.45，SD 0.4; p = 0.07）。哮喘导致的活动限制和持续性哮喘严重程度是与过去30天内报告任何症状日显着相关的唯一因素，并根据治疗组、过去6个月内口服皮质类固醇疗程数量和临床医生就诊次数、季节性、保险类型以及控制者与总哮喘药物比例协变量进行调整。结论一个以家庭为基础的照顾者哮喘沟通教育干预与症状天数减少无关。然而，在干预组中观察到控制者与总药物比率较高的趋势。市内哮喘儿童的看护者可能需要卫生系统的方法来帮助将儿童的哮喘健康信息传达给他们的临床医生。
Background. Effective pediatric guideline-based asthma care requires the caregiver to accurately relay the child's symptom frequency, pattern of rescue and controller medication use, and level of asthma control to the child's primary care clinician. Objective. This study evaluated the longitudinal effects of a caregiver-clinician asthma communication education intervention (ACE) relative to an asthma education control group (CON) on symptom days and controller medication use in inner-city children with asthma. Participants and Methods. 231 inner-city children with asthma, recruited from urban pediatric emergency departments (EDs) and community practices, were followed for 12 months. Data included number of symptom days and nights, ED visits, hospitalizations, presence of limited activity, and controller medication use over 12 months. Pharmacy records were used to calculate controller to total asthma medication ratios as a proxy of appropriate controller medication use. Multivariate logistic regression models were used to identify factors associated with number of symptom days and nights over the past 30 days at the 12-month follow-up. Results. Most caregivers rated the communication with their child's clinician as high. Unadjusted and adjusted rates of symptom days and nights did not differ by group at follow-up. ACE children trended towards a higher controller to total medication ratio at 12 months as compared to CON children (mean ratio: ACE: 0.54, SD 0.3; CON, 0.45, SD 0.4; p = .07). Activity limitation due to asthma and persistent asthma severity were the only factors significantly associated with reporting any symptom day within the past 30 days, adjusting for treatment group, number of oral corticosteroid courses and number of clinician visits in the last 6 months, seasonality, insurance type, and controller to total asthma medication ratio covariates. Conclusion. A home-based caregiver asthma communication educational intervention was not associated with decreased symptom days. However, a trend was noted in higher controller to total medication ratios in the intervention group. Inner-city caregivers of children with asthma may require a health systems approach to help convey the child's asthma health information to their clinician.