IMPROVING QUALITY OF LIFE OUTCOMES IN ASTHMA PATIENTS

正如2000年健康人群指南中所概述的，一个重要的国家健康目标，特别是对于服务不足的人群，是保持哮喘患者的功能状态。 本随机对照试验的目的是评估涉及教育、增强自我效能和电话社会支持的干预措施在180例不同社会人口学背景的中度哮喘患者中保持和改善功能状态的有效性。 目标还在于设计干预措施，以便在日常办公室实践中易于实施和加强。 假设是：1）增加自我效能、社会支持和哮喘教育的干预措施在2年内更有效地保持和改善功能状态; 2）抑郁症状越严重、合并症越多、获得哮喘护理的机会越少，一般自我效能和哮喘自我效能越低; 3）哮喘教育将导致对哮喘的知识和正确信念的增加，对哮喘的现实期望，以及对哮喘状态和治疗的更大满意度，4）自我效能感高、社会支持多、哮喘知识教育多的患者住院、急诊、急诊次数少。 对于对照组和实验组，干预措施将涉及向医生传播NHLBI专家小组的建议，以便医生提供患者教育和自我指导的NHLBI患者哮喘工作手册。 实验组还将接受量身定制的干预措施，以提高哮喘自我效能，通过与研究人员的电话联系获得哮喘社会支持，以及亲自加强或“助推器”干预措施。 主要结局是入组后2年哮喘生活质量问卷活动领域的患者内变化。其他结局将是通过使用SF-36的身体功能领域和综合身体评分测量2年后患者内功能状态的变化来评估干预的有效性，并通过根据住院、急诊室就诊和紧急医生办公室就诊测量2年内哮喘引起的资源利用来评估干预的有效性。 长期目标是证明建立在已经建立的有效干预措施基础上的干预措施可以在日常实践中容易地管理和加强，并可以促进哮喘患者的功能改善。

As outlined in the Healthy People 2000 guidelines, an important national health objective, especially for underserved populations, is to preserve functional status in patients with asthma. The goal of this randomized control trial is to assess the effectiveness of an intervention involving education, enhancement of self-efficacy, and telephone social support in preserving and improving functional status in 180 patients from diverse socio-demographic backgrounds with moderate asthma. The goal is also to design the intervention so that it is easy to implement and reinforce in day-to-day office practice. The hypotheses are that: 1) an intervention to increase self-efficacy, social support, and asthma education will be more effective in preserving and improving functional status over 2 years; 2) greater depressive symptoms, more comorbidity, and less access to asthma care will be associated with lower general self-efficacy and asthma self-efficacy; 3) education about asthma will result in increased knowledge and correct beliefs about asthma, realistic expectations about asthma, and greater satisfaction with asthma status and treatment, and 4) patients with higher self-efficacy, greater social support, and more education about asthma will have fewer hospitalizations, emergency room visits, and urgent doctor's office visits. For both control and experimental groups the intervention will involve dissemination to physicians of NHLBI Expert Panel recommendations for physician-provided patient education and a self-directed NHLBI patient asthma workbook. The experimental group also will receive a tailored intervention to increase asthma self-efficacy, asthma social support through telephone contact with study personnel, and in-person reinforcements or "boosters" of the interventions. The main outcome will be within-patient change in the Activities domain of the Asthma Quality of Life Questionnaire at 2 years after enrollment. Additional outcomes will be to assess the effectiveness of the intervention by measuring within-patient change in functional status after 2 years with the physical function domain and the compost physical score of the SF-36, and to assess the effectiveness of the intervention by measuring resource utilization due to asthma over 2 years according to hospitalizations, emergency room visits, and urgent doctor office visits. The long-term objectives are to demonstrate that an intervention that builds on already established effective interventions can be easily administered and reinforced in daily practice and can promote functional improvement in patients with asthma.