COMMUNITY PARTNERSHIP TO REDUCE ASTHMA DISPARITIES

描述（由申请人提供）：儿童哮喘在少数民族儿童中越来越常见，并导致相当大的医疗保健差距。本申请寻求在罗德岛医院和普罗维登斯社区卫生中心之间建立社区伙伴关系，以开展一项随机对照试验，以增加拉丁裔和非裔美国儿童哮喘控制药物的使用。由家长和主要举报人组成的社区咨询委员会将提供有关治疗实施的持续投入。有持续哮喘症状儿童的家庭将被纳入。将招募三组（N=240）：非裔美国人家庭、喜欢西班牙语医疗保健的拉丁裔家庭和喜欢英语医疗保健的拉丁裔家庭。所有家庭都将在一个短暂的基准期登记。服用口服或吸入控制药物的儿童将接受电子监控。研究人员还将从药房记录和保险索赔中收集有关基线药物使用的数据。哮喘知识、用药信念、药物依从性和哮喘发病率将在基线、治疗结束和治疗后3个月至1年后进行评估。在完成基线后，所有家庭将在他们自己的社区卫生中心（五个CHC之一）参加以小组为基础的哮喘教育课程。家庭将被随机分配到两种护士提供的干预措施中的一种，1)标准护理（SC）条件，强调使用症状监测、峰值流量计、触发控制措施和书面行动计划，或2)药物依从性（MA）条件，评估替代药物的使用，解决使用控制者药物的问题，并使用解决问题的技术来解决药物使用的障碍。随访由研究助理在干预后3、6、9和12个月时间点进行。预计这两种干预措施都将增加哮喘知识，但MA干预措施将产生更多的控制者药物使用和降低发病率。进一步预期治疗后药物依从性的差异会受到药物信念的中介作用。最后，预计在拉丁裔群体中，英语水平较低的拉丁裔人在药物依从性和发病率方面的基线变化最大。可持续发展顾问委员会将在赠款期满后就项目在社区的实施提供指导。

DESCRIPTION (provided by applicant): Pediatric asthma is increasingly common among minority children, and results in considerable healthcare disparity. This application seeks to establish a Community Partnership between Rhode Island Hospital and the Providence Community Health Centers to conduct a randomized, controlled trial to increase use of controller medications for asthma among Latino and African-American children. A Community Advisory Board of parents and key informants will provide ongoing input regarding treatment implementation. Families with children who have persistent asthma symptoms will be enrolled. Three groups will be recruited (N=240 total): African-American families, Latino families who prefer health care in Spanish, and Latino families who prefer health care in English. All families will be enrolled in a brief baseline period. Children who are prescribed oral or inhaled controller medications will have medication use monitored electronically. Research staff will also collect data regarding baseline medication use from pharmacy records and insurance claims. Asthma knowledge, medication beliefs, medication adherence, and asthma morbidity will be assessed at baseline, end of treatment, and at 3-month intervals until 1 year post-treatment. After completing a baseline, all families will attend a group-based asthma education class in their own Community Health Center (one of five CHC's). Families will the be randomized to one of two nurse delivered interventions, either 1) a Standard Care (SC) condition, which emphasizes use of symptom monitoring, peak flow meter, trigger control measures, and a written action plan, or 2) a Medication Adherence (MA) condition, which assesses use of alternative medications, addresses concerns regarding use of controller medications, and uses problem-solving techniques to address barriers to medication use. Follow-up is conducted by researcher assistants at 3-, 6-, 9-, and 12-month time points post-intervention. It is expected that both interventions will increase asthma knowledge, but the MA intervention will yield greater controller medication use and decreased morbidity. It is further expected that differences in medication adherence post-treatment will be mediated by medication beliefs. Lastly, it is anticipated that within the Latino groups, Latinos with low English proficiency will demonstrate the greatest changes from baseline on medication adherence and morbidity. A Sustainability Advisory board will provide guidance regarding project implementation in the community beyond the life of the grant.