Cueing Patient-Clinican Collaboration to Improve Asthma

提示患者与临床合作改善哮喘

• 批准号: 6994431
• 负责人: Susan L Janson
• 金额: $ 52.22万
• 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/6994431
• 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、潜在威胁生命的疾病，在美国影响着1700万人。哮喘每年造成生产活动中数百万工作日的损失和数以千计的住院治疗。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最有效的药物，通过吸入给药可以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皮质类固醇（ICS）有益，但患者和临床医生似乎都不愿意定期使用它们。许多开了ICS处方的患者要么从不服用，要么服用频率较低（例如，每天一次而不是两次），服用频率较低（例如，“按需”而不是每天），或者剂量低于处方。调查人员和审稿人一致认为，至少有50%的患者由于依从性差而未能充分受益。不遵守的原因是多方面的，并没有完全理解。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器。提供有关哮喘相关肺功能的相关客观信息应促进患者和临床医生之间的治疗沟通，以提高对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相互作用来改善抗炎药物依从性和哮喘预后。具体目的是：1)通过引导医患沟通，反馈气流阻塞的客观信息，加强服药行为，提高ICS用药依从性；2)记录提示干预对医疗保健结果（医疗保健利用、肺功能、口服类固醇抢救疗程的需求和功能影响）的影响。我们假设，提示患者和他们的初级保健临床医生气流阻塞的程度将促进他们之间的相互作用，导致比对照组中没有收到反馈的类似患者在一年内更坚持使用ICS药物。提出了一项前瞻性随机临床试验（N=150名受试者）来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。三个全科医学实践的所有临床医生和他们的成人中度至重度哮喘患者的个体小组将被纳入，并随机分配到干预组或常规护理组。与当前治疗相关的解释峰流图的反馈将促进治疗交流。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性对话。改善中度或重度哮喘患者对ICS的依从性已被证明可降低哮喘发病率并改善健康结果。