Trial of Asthma Patient Education in the Emergency Room

描述（由申请人提供）：本研究的目标是将一个成功的哮喘教育项目转化为在急诊科（ED）接受治疗的患者。该建议是以患者为导向的临床研究轨迹的一部分，旨在改善哮喘患者的预后。它建立在之前两项成功研究的基础上。第一项研究由Robert Wood Johnson基金会支持，是一项针对224名成人初级保健患者的完整研究，该研究表明，患者自我效能感较低，抑郁症状较多，对治疗的不切实际期望预示着2年内生活质量的恶化和紧急资源利用率的增加。这些发现促使一项正在进行的NHLBI K23随机对照试验对180名成人初级保健哮喘患者实施多成分教育干预。本试验的初步结果表明，这种干预在改善生活质量和紧急资源利用方面是有效的。因此，本随机对照试验的具体目的是测试一种干预措施，以提高纽约市两家急诊科296名成年哮喘患者的知识、自我效能感和哮喘相关的社会支持。干预措施将在急诊室（或住院病人的医院）进行一次单独的面对面会议，随后进行电话强化。主要结果将是患者从入组到8周的总体哮喘生活质量问卷得分的变化。第8周和第16周的其他结果将是β受体激动剂的使用量、峰值流量、旷工率、紧急资源利用率和项目的成本效益。该程序的新颖之处在于：易于管理；重点关注迫切需要哮喘教育的ED患者；它结合了自我效能，这是哮喘自我管理的一个重要方面，在ED项目中还没有经过严格的测试。长期目标是通过提供具有成本效益和临床有效的项目可以成功实施的证据，促进ED的项目，这是一个在哮喘教育方面服务不足的环境。其他长期目标是将该项目作为ED、初级保健和学校环境中针对儿童、青少年及其照顾者的类似项目的基础。

DESCRIPTION (provided by applicant): The goals of this study are to translate a successful asthma education program to patients who are treated in the emergency department (ED). This proposal is part of a trajectory of patient-oriented clinical research aimed at improving outcomes in asthma patients. It builds on two prior successful studies. The first, supported by the Robert Wood Johnson Foundation, is a completed study with 224 adult primary care patients that showed that less patient self-efficacy, more depressive symptoms, and unrealistic expectations of treatment predicted deterioration in quality of life and increased urgent resource utilization over 2 years. These findings led to an ongoing NHLBI K23 randomized controlled trial to implement a multi-component education intervention with 180 adult primary care asthma patients. Preliminary results from this trial indicate that this intervention is effective in improving quality of life and urgent resource utilization. Therefore, the specific aim of this proposed randomized controlled trial is to test an intervention to enhance knowledge, self-efficacy and asthma-related social support in 296 adult patients being treated for asthma in two EDs in New York City. The intervention will be administered during a single in-person session in the ED (or hospital for admitted patients) followed by telephone reinforcement. The primary outcome will be the within-patient change in overall Asthma Quality of Life Questionnaire scores from enrollment to 8 weeks. Additional outcomes at 8 and 16 weeks will be the amount of beta agonists used, peak flow rates, work absenteeism, urgent resource utilization, and cost-effectiveness of the program. The novel features of this program are: it is easy to administer; it focuses on ED patients who are in great need of asthma education; and it incorporates self-efficacy, an important aspect of asthma self-management that has not been rigorously tested in ED programs. The long-term objectives are to foster programs in the ED, a setting that has been underserved regarding asthma education, by providing evidence that cost-effective and clinically effective programs can be successfully implemented. Other long-term objectives are to use the program as a basis for similar programs for children, adolescents and their caregivers in the ED, primary care, and school settings.