Using the telephone to improve care in childhood asthma

描述(申请人提供)：哮喘是最常见的儿童慢性病，也是美国发病率的主要原因。如果哮喘症状得到控制，哮喘儿童就可以保持良好状态，过上正常的生活。每天使用吸入性类固醇可以控制症状，减少持续性哮喘儿童的发病率和紧急医疗保健的使用，长期使用是安全的。然而，吸入性类固醇在社区哮喘护理中没有得到充分利用。在社区为哮喘儿童提供有效的预防护理需要从反应导向转变为父母和医生的积极导向。父母必须积极参与孩子的哮喘管理。结构化的自我管理计划，包括协作性目标设定、自我管理培训和支持，以及积极的持续跟踪，改善慢性病患者的预后。提供者发起的呼叫已被证明是向慢性病患者提供常规护理和行为干预的有效方式，并降低了发病率和卫生服务的利用率。重新设计初级保健，分担哮喘护理的工作，并使用电话为父母实施自我管理计划，为社区儿童提供最佳哮喘护理提供了一种有效的方式。经验丰富的华盛顿大学哮喘研究人员和Wu PAARC社区儿科医生网络之间的合作为在先前工作的基础上再接再厉并在初级保健环境中评估这种方法提供了机会。 电话哮喘计划(TAP)包括与训练有素的护士进行一系列简短、积极的电话咨询，以加强儿童儿科医生提供的护理，并促进父母的自我管理。护士将监测症状，教授自我管理技能，与父母合作，增加吸入类固醇的有效使用，提供支持，并提醒父母去儿科医生那里进行后续护理。我们假设，电话哮喘计划将减少需要紧急护理的哮喘急性加重的发生率，改善哮喘儿童及其父母的生活质量，并增加持续性哮喘儿童的吸入性类固醇的日常使用。我们将在一项随机对照试验中评估电话哮喘计划，该试验涉及360名5至12岁的儿童，由圣路易斯Wu PAARC的儿科医生成员照顾。

DESCRIPTION (Provided by Applicant): Asthma is the most common chronic disease of childhood and a major cause of morbidity in the United States. If asthma symptoms are controlled, a child with asthma can stay well and lead a normal life. Daily use of inhaled steroids controls symptoms and reduces morbidity and emergent health care utilization in children with persistent asthma, and is safe for long-term use. However, inhaled steroids are underutilized in community asthma care. Delivering effective preventive care for children with asthma in the community requires a change from a reaction orientation towards a proactive orientation for both parents and physicians. The parent must be actively involved in the child's asthma management. Structured self-management programs that include collaborative goal setting, self-management training and support, and active sustained follow-up, improve outcomes in patients with chronic diseases. Provider-initiated calls have been shown to be an effective way to deliver routine care and behavioral interventions to patients with chronic diseases, and have reduced morbidity and utilization of health services. Redesigning primary care to share the work of asthma care, and use the telephone to implement a self-management program for parents offers an efficient way to provide optimal asthma care for children in the community. Collaboration among experienced Washington University asthma researchers and the WU PAARC network of community pediatricians affords an opportunity to build on previous work and evaluate this approach in the primary care setting. The Telephone Asthma Program (TAP) comprises a series of brief, proactive telephone consultations with a trained nurse to augment the care provided by the child's pediatrician and facilitate self-management by the parent. The nurse will monitor symptoms, teach self-management skills, collaborate with the parent to increase effective use of inhaled steroids, provide support and remind the parent to go for follow-up care with the pediatrician. We hypothesize that the Telephone Asthma Program will reduce the incidence of acute exacerbations of asthma that require emergent care, improve the quality of life of children with asthma and their parents, and increase the daily use of inhaled steroids in children with persistent asthma. We will evaluate the Telephone Asthma Program in a randomized controlled trial involving 360 children aged 5 to 12 years old cared for by pediatrician members of WU PAARC in St Louis.