EFFICACY OF WRITTEN TREATMENT PLANS IN ASTHMA

哮喘书面治疗计划的疗效

• 批准号: 6790593
• 负责人: David Evans
• 金额: $ 69.69万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-08-13 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6790593
• 关键词: asthma; behavioral /social science research tag; clinical research; health care personnel performance; health care service evaluation; health care service utilization; health disparity; health services research tag; human subject; outcomes research; patient care management; patient care planning; patient oriented research; racial /ethnic difference

DESCRIPTION (provided by applicant): Effective self-management of asthma requires that patients or their caregivers recognize the early symptoms of an exacerbation and initiate appropriate interventions aimed at preventing the progression of symptoms. Most asthma clinical guidelines suggest that the incorporation of a written self-management plan is an essential tool that patients must possess, be able to understand, and follow if they are to respond appropriately to changes in asthma status. Nevertheless, there are no controlled trials examining the efficacy of the written plan itself. Furthermore, even if written plans are an essential and an effective component of successful self-management, the data suggest that few patients receive them. Barriers to the use of written plans need more study if patients and physicians are to increase their use of this tool. Additionally, studies are needed to examine the efficacy of written plans across different patient populations. The overall goal of this study is to assess the efficacy of a model, written treatment plan in a randomized, controlled trial (RCT) compared with the usual care that is provided by a group of adult and pediatric pulmonologists and allergists in their practice settings. The model plan is a form that allows a treatment regimen consistent with NHLBI guidelines to be conveyed to patients. An additional goal is to assess how patients from different racial/ethnic backgrounds utilize treatments plans. Specific aims: 1) to identify barriers to the use of written plans and determine whether these barriers differ across racial/ethnic groups; 2) to develop, validate, and pilot test a model written treatment plan form plus instructions to doctors for its use; and 3) to conduct a RCT of the model plan form with African-American, Latino, and non-Latino white patients to: a) assess the efficacy of the plan across patient populations and b) determine if using written plans reduce racial/ethnic disparities in asthma outcomes. We hypothesize that patients with asthma who receive the model written plan form will have, relative to patients in the control group, significantly greater improvement in 3 primary outcome measures: 1.1) reduction in asthma symptom frequency; 1.2) reduction in emergency use of health care services; and 1.3) improved quality of life. We will also examine 4 secondary outcome measures: 1.4) asthma hospitalizations; 1.5) days with activity restriction; 1.6) the proportion of patients in the intervention group who receive the plan during the initial visit; and 1.7) use of the plans by patients.

描述（由申请人提供）：哮喘的有效自我管理要求患者或其护理人员认识到急性发作的早期症状，并启动旨在预防症状进展的适当干预措施。大多数哮喘临床指南建议，如果患者要对哮喘状态的变化做出适当的反应，那么将书面的自我管理计划纳入其中是患者必须拥有、能够理解并遵循的重要工具。然而，没有对照试验检查书面计划本身的有效性。此外，即使书面计划是成功的自我管理的一个重要和有效的组成部分，数据表明，很少有患者接受他们。如果患者和医生要增加使用书面计划的话，就需要对使用书面计划的障碍进行更多的研究。此外，还需要进行研究，以检查书面计划在不同患者人群中的有效性。本研究的总体目标是在一项随机对照试验（RCT）中评估一种模型、书面治疗计划与一组成人和儿童肺病学家和过敏症专家在其实践环境中提供的常规治疗相比的疗效。该模型计划是一种允许将与NHLBI指南一致的治疗方案传达给患者的形式。另一个目标是评估来自不同种族/民族背景的患者如何利用治疗计划。具体目标：1）识别使用书面计划的障碍，并确定这些障碍是否在种族/族裔群体中存在差异; 2）开发、验证和试点测试一份书面治疗计划表范本以及医生使用说明; 3）对非裔美国人、拉丁裔和非拉丁裔白色患者进行一项计划表范本的RCT，以：a）评估该计划在患者人群中的有效性和B）确定使用书面计划是否减少哮喘结局中的种族/民族差异。我们假设，与对照组患者相比，接受标准书面计划表的哮喘患者在3个主要结局指标方面的改善显著更大：1.1）哮喘症状频率减少; 1.2）紧急使用卫生保健服务减少; 1.3）生活质量改善。我们还将检查4个次要结局指标：1.4）哮喘住院; 1.5）活动受限天数; 1.6）干预组中在首次访视期间接受计划的患者比例; 1.7）患者使用计划。