Does Shared Decision-Making Improve Adherence in Asthma?

描述（由申请人提供）：哮喘症状控制，不经常使用 急救药物、正常活动和罕见/无急诊访视， 住院和死亡是目前可用的现实预期 药物治疗，但依从性不足会损害控制， 特别是对于少数民族和低收入患者。共同决策（SDM） 管理模式，提出了消除病人的喜好和障碍， 让患者选择哮喘治疗。该模型基于 社会/认知学习理论和行为改变理论（患者作为积极的 代理人/动机面试，准备改变/可行性）， 建议作为提高依从性的一种手段。SDM的对照试验 最近获得资助的一个模型，专注于疾病的结果， （其次）342例高加索人和亚洲/太平洋岛屿人样本的依从性 凯撒成员（波特兰，夏威夷），同一个团队现在提出了一个平行的审判 在300名非洲裔美国人、中国人、拉丁美洲人和其他少数民族/低收入凯撒人中， 北方加州的成员。主要结局将是基于药物的 控制者用药依从性指数，急救药物使用，哮喘 控制、生活质量和急性哮喘卫生保健利用作为次要因素 成果。干预效果将在少数群体中确定， 合并样本（n=642）;将在母研究中分析疾病结局。 社会心理特征的测量，可能与文化有关， 将其添加到联合研究方案中，以调查依从性的相关性 和“机械”的假设重新因果关系之间的态度变化，改善 依从性和疾病结果。在第一阶段，我们将使用 患者和临床医生，以完善干预，以适应充分的 不同人群的多样性。在第二阶段， 将使用KP电子数据库招募受控制的持续性哮喘。 合格患者（n=300）将随机（1：1：1）接受SDM治疗， 以国家指南为基础的管理和常规护理。鼻饲病人 干预武器将会见一个护理经理在两个会议上，有他们的 根据指定的模式，对管理计划进行必要的审查和修改， 并在3个月、6个月和9个月时打电话。所有参与者将接受2次随访 在12和24个月时进行评估。这是一个独特的机会来测试一个 在少数人群中进行依从性干预， 在以白人为主的人群中进行平行试验，并了解 连接态度、依从性和哮喘结果的机制。

DESCRIPTION (provided by applicant): Asthma symptom control, infrequent use of rescue medications, normalized activities, and rare/no emergency visits, hospitalizations, and deaths are realistic expectations of currently available pharmacologic treatment, but inadequate adherence compromises control, especially for minority and low income patients. A shared decision-making (SDM) management model is proposed that elicits patient preferences and barriers and involves the patient in choosing asthma therapy. The model is based on social/cognitive learning theory and behavior change theory (patients as active agents/motivational interviewing, readiness for change/feasibility), and is proposed as a means of improving adherence. A controlled trial of the SDM model, recently approved for funding, focuses on disease outcomes and (secondarily) adherence in a sample of 342 Caucasian and Asia/Pacific Island Kaiser members (Portland, Hawaii), The same team now proposes a parallel trial in 300 African American, Chinese, Latino, and other minority/low-income Kaiser members in Northern California. The primary outcome will be a pharmacy-based controller medication adherence index, with rescue medication use, asthma control, quality of life, and acute asthma health care utilization as secondary outcomes. Intervention effects will be determined among minorities and in the combined sample (n=642); disease outcomes will be analyzed in the parent study. Measures of psychosocial characteristics, potentially culturally-linked, will be added to the joint research protocol to investigate correlates of adherence and "mechanistic" hypotheses re causal links between attitude change, improved adherence, and disease outcomes. In Phase I, we will use focus groups of patients and of clinicians to refine the intervention to accommodate the full diversity of the various populations. In Phase II, patients with suboptimally controlled, persistent asthma will be recruited using KP electronic databases. Eligible patients (n=300) will be randomized (1:1:1) to SDM management, national guidelines-based management, and usual care. Patients in both intervention arms will meet with a care manager in two sessions, have their management plan reviewed and modified as necessary, per their assigned model, and be phoned at 3, 6, and 9 months. All participants will be followed for 2 years and assessed at 12 and 24 mos. This is a unique opportunity to test an adherence intervention in a minority population, increase the value of a parallel trial in a predominantly Caucasian population, and understand the mechanisms linking attitudes, adherence, and asthma outcomes.