Family Routines & Medical Adherence in Children with Asthma: A Tailored Intervent

家庭日常事务

• 批准号: 7530640
• 负责人: BARBARA H FIESE
• 金额: $ 19.48万
• 依托单位: UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-18 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7530640
• 关键词: 12 year old; Accident and Emergency department; Adherence; Adolescent; Affect; Asthma; Calendar; Caregivers; Caring; Child; Chronic; Chronic Disease; Clinical; Collection; Communication; Condition; Control Groups; Cystic Fibrosis; Daily; Diabetes Mellitus; Education; Emotional; Enrollment; Family; Focus Groups; Health; Health Care Costs; Home environment; Intervention; Life; Medical; Methodology; Numbers; Parents; Pharmaceutical Preparations; Physicians; Population Heterogeneity; Practice Management; Primary Health Care; Protocols documentation; Public Health; Quality of life; Randomized Clinical Trials; Rate; Schools; Self Efficacy; Self Management; Series; Standards of Weights and Measures; Toothbrushing; Treatment Protocols; United States; United States National Institutes of Health; Visit; Week; Youth; base; care burden; cost; day; family management; follow-up; improved; intervention program; medication compliance; respiratory; response; toothbrush

DESCRIPTION (provided by applicant): This proposal is in response to PA-07-099 Chronic Illness Self-Management in Children and Adolescents. A pilot intervention is proposed to improve self-management and quality of life of youth with asthma. Poor asthma management practices cost 3.2 billion dollars per year in health care costs. Non-adherence to prescribed protocols is high, with less than half of children following physician's orders. The results of this R21 will inform a full randomized clinical trial and the methodology employed may be applicable to other chronic health conditions such as diabetes and cystic fibrosis. The objectives of the PA are fulfilled by focusing on medical adherence, family functioning, and tailored interventions. The proposal aims to improve family based management strategies by building on daily routines, effecting direct communication between parent and child, and reducing emotional burden of care. First, a series of focus groups will be conducted with 30, 8-12 year old children with persistent asthma and their primary caregivers. Families will be presented a collection of helpful hints of asthma management strategies suggested by 200 families in another NIH study. The hints are framed as part of the family's daily routines and are geared to improve medical adherence. The caregivers and children will complete ratings of acceptability for each of the routines and discuss barriers in adhering to medical regimens. Based on the acceptability ratings and focus group discussions, a set of routines will be identified for a tailored intervention in a primary care setting. Second, 30 children between 8 and 12 years old with persistent asthma and their caregivers will be enrolled in an intervention group. Baseline recordings of medication adherence will be taken for 4 weeks and then reviewed with the child and parent during a primary care visit with a respiratory therapist. The child and caregiver will be presented a menu of routines drawn from the focus group (e.g., using calendars, placing medications by tooth brush, planning for sleepovers) and asked to select six that will fit best with their own barriers and family life. Cards or objects representing the routines will be placed in a Family Backpack for the child to take home. A control group of 30 children with asthma will receive standard asthma education from the respiratory therapist. Three- and six-month follow up will be used to compare the groups on levels of medication adherence, quality of life, and self efficacy. Results of the project will be used to develop a large scale randomized clinical trial in primary care settings serving diverse populations of children with persistent asthma. 7. PUBLIC HEALTH RELEVANCE: Of the nine million children in the United States that were affected by asthma in 2002, four million had an asthma attack and close to one million were seen in emergency departments, while over $3 billion was spent in asthma care. Asthma is a controllable condition and adherence to prescribed medications can reduce expensive health care costs and reduce the number of school days missed due to asthma. This tailored yet practical and feasible intervention aims to increase medical adherence by building on family routines that will make it easier to remember to take daily medications.

描述(申请人提供)：本提案是针对PA-07-099《儿童和青少年慢性病自我管理》而提出的。建议进行试点干预，以提高哮喘青少年的自我管理能力和生活质量。糟糕的哮喘管理做法每年造成32亿美元的医疗费用。不遵守规定方案的比例很高，只有不到一半的儿童听从医生的命令。这项R21试验的结果将成为一项完全随机的临床试验，所采用的方法可能适用于其他慢性健康状况，如糖尿病和囊性纤维化。PA的目标是通过关注医疗依从性、家庭功能和量身定做的干预来实现的。该建议旨在通过建立日常生活、实现父母和孩子之间的直接沟通以及减轻照顾的情感负担来改进以家庭为基础的管理策略。首先，将对30、8-12岁患有持续性哮喘的儿童及其主要照顾者进行一系列焦点小组调查。在NIH的另一项研究中，200个家庭将向家庭展示哮喘管理策略的有用提示。这些提示被框定为家庭日常生活的一部分，旨在提高对医疗的依从性。照顾者和孩子们将完成每一项例行公事的可接受性评级，并讨论遵守医疗方案的障碍。根据可接受性评级和焦点小组讨论，将确定一套在初级保健环境中进行量身定制干预的常规程序。其次，30名8至12岁患有持续性哮喘的儿童和他们的照顾者将被纳入干预组。服药依从性的基线记录将被记录4周，然后在与呼吸治疗师进行初级保健访问期间与孩子和父母一起审查。将向孩子和照顾者展示一份从焦点小组中提取的常规程序菜单(例如，使用日历、通过牙刷放置药物、计划过夜)，并要求他们选择六种最适合他们自己的障碍和家庭生活的程序。代表例行公事的卡片或物品将被放在一个家庭背包里，供孩子带回家。对照组30名哮喘儿童将从呼吸治疗师那里接受标准的哮喘教育。三个月和六个月的随访将用于比较两组的服药依从性、生活质量和自我效能。该项目的结果将用于在初级保健环境中开发一项大规模随机临床试验，为不同人群的持续性哮喘儿童提供服务。7. 与公共卫生相关：2002年，美国有900万儿童患有哮喘，其中400万儿童哮喘发作，近100万儿童在急诊室就诊，而哮喘治疗花费了30多亿美元。哮喘是一种可控的疾病，坚持服用处方药可以降低昂贵的医疗费用，并减少因哮喘而缺课的天数。这一量身定制但实用可行的干预措施旨在通过建立家庭惯例来提高对医疗的依从性，从而使人们更容易记住每天服用药物。