Using the telephone to improve care in childhood asthma

描述（由申请人提供）：哮喘是儿童最常见的慢性疾病，也是美国发病率的主要原因。如果哮喘症状得到控制，患有哮喘的孩子就能保持健康，过上正常的生活。每日使用吸入类固醇可控制症状，降低持续性哮喘儿童的发病率和急诊使用率，并且长期使用是安全的。然而，吸入性类固醇在社区哮喘护理中的利用不足。在社区为哮喘儿童提供有效的预防保健需要父母和医生从反应导向转变为主动导向。家长必须积极参与孩子的哮喘管理。结构化的自我管理项目，包括协作目标设定、自我管理培训和支持，以及积极持续的随访，可以改善慢性病患者的预后。由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法，并降低了发病率和保健服务的利用率。重新设计初级保健以分担哮喘护理工作，并使用电话实施家长自我管理程序，为社区儿童提供最佳的哮喘护理提供了一种有效的方法。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提供了一个机会，可以在以前的工作基础上，在初级保健环境中评估这种方法。

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.