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。本申请旨在建立罗得岛医院和普罗维登斯社区卫生中心之间的社区合作伙伴关系，以进行随机对照试验，增加拉丁裔和非洲裔美国儿童哮喘控制药物的使用。一个由家长和主要知情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入组。将招募三组（共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。所有家庭将在一个简短的基线期内入组。口服或吸入控制药物的儿童将接受电子监测。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。将在基线、治疗结束时和治疗后1年内每隔3个月评估一次哮喘知识、用药信念、用药依从性和哮喘发病率。在完成基线后，所有家庭将参加在他们自己的社区卫生中心（五个CHC之一）举办的基于小组的哮喘教育课程。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，解决有关控制药物使用的问题，并使用解决问题的技术来解决药物使用的障碍。在干预后3个月、6个月、9个月和12个月的时间点由研究助理进行随访。预计这两种干预措施将增加哮喘知识，但MA干预措施将产生更多的控制药物使用和降低发病率。进一步预计，治疗后药物依从性的差异将由药物信念介导。最后，预计在拉丁美洲人群中，英语水平低的拉丁美洲人将在药物依从性和发病率方面表现出较基线的最大变化。一个可持续发展咨询委员会将提供指导，在社区项目的实施超过了赠款的生命。

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.