Cueing Patient-Clinican Collaboration to Improve Asthma

提示患者与临床合作改善哮喘

• 批准号: 6730339
• 负责人: Susan L Janson
• 金额: $ 51万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-12-09 至 2007-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6730339
• 关键词: asthma; behavioral /social science research tag; chronic obstructive pulmonary disease; clinical research; communication; corticosteroids; cues; health behavior; health care service utilization; human subject; inhalation drug administration; patient care personnel relations; primary care physician; respiratory therapy; spirometry; therapy compliance

DESCRIPTION (provided by applicant): Asthma is a chronic, potentially life-threatening disease that affects 17 million people in the United States. Millions of lost work days from productive activity and thousands of hospitalizations annually are caused by asthma. Despite the high prevalence, asthma is a chronic disease that can be controlled. Corticosteroids are the most effective agents for the long-term treatment of persistent asthma, and administration by inhalation minimizes the potential for systemic side effects. Despite convincing evidence of the benefits of inhaled corticosteroids (ICS), both patients and clinicians seem reluctant to use them regularly. Many patients who are prescribed ICS either never take them, or take them less frequently (e.g., once rather than twice daily), less regularly (e.g., "as needed" rather than daily), or at lower doses than prescribed. Investigators and reviewers agree that at least 50% of persons for whom medications are prescribed fail to benefit fully because of poor adherence. The reasons for nonadherence are multifaceted and not fully understood. The relationship between clinician and patient, an area where potential impact can be made, is believed to be the strongest predictor of medication adherence. Providing pertinent objective information about asthma related lung function should prompt therapeutic communication between the patient and clinician to improve adherence to ICS. The overall purpose of this project is to improve anti-inflammatory medication adherence and asthma outcomes by cueing therapeutic interaction between patients and their clinicians. The specific aims are to 1) improve adherence to ICS medication by cueing patient-clinician communication with feedback of objective information about airflow obstruction to reinforce medication-taking behavior; and 2) to document the impact of this cueing intervention on health care outcomes (health care utilization, pulmonary function, need for rescue courses of oral steroids, and functional impact. We hypothesize that cueing patients and their primary care clinicians about the degree of airflow obstruction will prompt interaction between them resulting in greater adherence to ICS medication over one year than will occur in a control group of similar patients who do not receive feed-back. A prospective randomized clinical trial (N=150 subjects) is proposed to test the effectiveness of this intervention. Promoting communication between adults with asthma and their clinicians in a primary care clinical setting has not yet been demonstrated. All clinicians within three general medicine practices and their individual panels of adult patients with moderate to severe asthma will be enrolled and randomized together to either the intervention or usual care. Feedback of interpreted peak flow graphs in relation to current therapy will prompt therapeutic communication. The intent is to cue and support the therapeutic relationship between clinician and patient rather than to directly intervene. The power of cueing communication lies in the ensuing therapeutic dialogue. Improvement of adherence to ICS among people with moderate or severe asthma has been shown to decrease morbidity of asthma and improve health outcomes.

描述（由申请人提供）：哮喘是一种慢性，可能危及生命的疾病，影响美国1700万人。哮喘每年造成数百万工作日的生产活动损失和数千人住院治疗。尽管发病率很高，但哮喘是一种可以控制的慢性疾病。皮质类固醇是长期治疗持续性哮喘的最有效药物，吸入给药可最大限度地减少全身副作用的可能性。尽管有令人信服的证据表明吸入性皮质类固醇（ICS）的益处，但患者和临床医生似乎都不愿意定期使用它们。许多接受ICS处方的患者要么从不服用ICS，要么服用频率较低（例如，每天一次而不是两次），较不规律地（例如，“按需”而不是每日），或以低于处方的剂量。研究者和评论者一致认为，至少有50%的人，他们的药物处方未能充分受益，因为遵守不良。不遵守的原因是多方面的，尚未得到充分理解。临床医生和患者之间的关系，一个可以产生潜在影响的领域，被认为是药物依从性的最强预测因子。提供有关哮喘相关肺功能的客观信息应促进患者和临床医生之间的治疗沟通，以提高ICS的依从性。该项目的总体目的是通过提示患者与其临床医生之间的治疗互动来改善抗炎药物依从性和哮喘结局。具体目的是：1）通过提示患者-临床医生沟通，反馈有关气流阻塞的客观信息，以加强服药行为，从而提高ICS药物的依从性; 2）记录这种提示干预对医疗保健结局的影响（医疗保健利用、肺功能、口服类固醇补救疗程的需求和功能影响。我们假设，提示患者及其初级保健临床医生气流阻塞的程度将促使他们之间的相互作用，导致一年内对ICS药物的依从性高于未接受反馈的类似患者的对照组。拟进行一项前瞻性随机临床试验（N=150例受试者），以检验该干预措施的有效性。在初级保健临床环境中促进成人哮喘患者与其临床医生之间的沟通尚未得到证实。三个全科医学实践中的所有临床医生及其个体中重度哮喘成人患者组将入组，并随机分配至干预组或常规治疗组。与当前治疗相关的解释峰值流量图的反馈将促进治疗沟通。其目的是提示和支持临床医生和患者之间的治疗关系，而不是直接干预。暗示沟通的力量在于随后的治疗对话。在中度或重度哮喘患者中，改善ICS依从性已被证明可降低哮喘发病率并改善健康结局。