School-Based Asthma Care for Teens (SB-ACT)

青少年学校哮喘护理 (SB-ACT)

• 批准号: 8606964
• 负责人: Jill S Halterman
• 金额: $ 79.07万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-17 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8606964
• 关键词: Absenteeism; Accident and Emergency department; Accounting; Adherence; Adolescent; American Lung Association; Asthma; Attention; Belief; Caring; Cessation of life; Child; Childhood; Chronic Disease; Cities; Clinical; Communities; Complex; Counseling; Depressed mood; Directly Observed Therapy; Economics; Education; Effectiveness; Evaluation; Goals; Guideline Adherence; Guidelines; Healthcare; Hospitalization; Inflammation; Intervention; Learning; Low income; Mediator of activation protein; Medicaid; Minority; Modeling; Modification; Morbidity - disease rate; Motivation; National Heart, Lung, and Blood Institute; Nature; Neighborhoods; Nurses; Nursing Schools; Outcome; Parents; Pharmaceutical Preparations; Phase; Play; Population; Preventive; Process; Program Effectiveness; Provider; Public Health; Quality of life; Randomized; Research Infrastructure; Resources; Risk; Role; Schedule; School Nursing; Schools; Secondary Schools; Specific qualifier value; Surveys; Symptoms; System; Techniques; Teenagers; Testing; Time; Training; Visit; Work; age group; arm; base; chronic care model; clinically significant; comparison group; cost effective; demographics; design; elementary school; experience; functional outcomes; health disparity; health economics; improved; inner city; innovation; intervention effect; medication compliance; member; mortality; motivational enhancement therapy; novel; post intervention; prevent; programs; public health relevance; satisfaction; success; therapy design

DESCRIPTION (provided by applicant): Asthma is the most common chronic illness of childhood, and despite current advances in therapies, morbidity and mortality continue to increase. Low-income, minority teenagers have disproportionately high rates of asthma morbidity, including excess risk of emergency department care, hospitalization, and death from asthma, compared to white adolescents. Although urban children suffer the largest burden from asthma, they are the least likely group to receive adequate preventive care, and poor adherence plays a significant contributing role in asthma morbidity. Inner city adolescents with asthma are at particular risk of nonadherence. Thus, there is a substantial amount of suffering that could be prevented with improvements in care. This application builds on our extensive experience with efficacious school-based programs for urban children and teens with asthma. The overall goal is to broadly disseminate a novel system of asthma care throughout the entire city school district ('School Based Asthma Care for Teens'; SBACT), and test its effectiveness in improving adherence and reducing morbidity among urban teens. The SB-ACT intervention includes two core components. First, adolescents visit the school nurse daily for 6-8 weeks at the start of the school year to receive a trial of directly observed therapy (DOT) of preventive asthma medications. The goal is for the teen to establish a relationship with the nurse, learn proper medication technique, and experience the benefits and value of daily preventive therapy. Four to 6 weeks after the initiation of DOT, the teen will receive a motivational interviewing (MI) counseling program designed to enhance the teen's motivation to transition to independent, sustained preventive medication use. We will train community-based nurses affiliated with the local American Lung Association to deliver the MI component. The MI nurse will conduct three counseling sessions with the teen at school, which are designed to capitalize on the teen's experience with DOT and the potential benefits they experienced. Given the complex nature of asthma care in this population, we plan to evaluate this intervention using a 3-group design in which 430 teens will be randomly assigned to either; 1) the SB-ACT program (trial of DOT for 6-8 weeks + 3 MI counseling sessions); 2) DOT-only (DOT only for 6-8 weeks); or 3) an asthma education (AE) comparison group (in-school asthma education delivered by a trained asthma educator). We include the DOT-only group to evaluate whether this component alone is sufficient to promote sustained adherence without counseling. The AE group is designed to enhance asthma care and control for the attention received in MI counseling. We will assess the effectiveness of the SB-ACT intervention in reducing asthma morbidity, perform an economic sustainability analysis, and evaluate each component of program implementation with a focus on sustainability and dissemination. At the completion of the study, the effectiveness of this system of school-based asthma care will be better defined as a sustainable means to improve care for adolescents and reduce health disparities.

描述（由申请人提供）：哮喘是儿童最常见的慢性疾病，尽管目前治疗取得了进展，但发病率和死亡率仍在增加。与白人青少年相比，低收入、少数族裔青少年的哮喘发病率高得不成比例，包括急诊、住院和哮喘死亡的风险过高。尽管城市儿童承受着最大的哮喘负担，但他们是最不可能获得充分预防保健的群体，而且依从性差在哮喘发病率中起着重要作用。患有哮喘的市中心青少年尤其有不遵守规定的风险。因此，可能会有大量的痛苦