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

描述（由申请人提供）：哮喘是儿童期最常见的慢性疾病，尽管目前治疗方法取得了进展，但发病率和死亡率仍在继续增加。与白色青少年相比，低收入、少数民族青少年的哮喘发病率不成比例地高，包括急诊室护理、住院和哮喘死亡的过度风险。虽然城市儿童遭受哮喘的最大负担，但他们是最不可能接受适当预防护理的群体，并且依从性差在哮喘发病率中起着重要作用。内城青少年哮喘患者有特殊的不依从风险。 因此，有大量的痛苦， 通过改善护理来预防。此应用程序建立在我们为城市儿童和青少年哮喘有效的校本计划的丰富经验之上。总体目标是在整个城市学区广泛传播一种新的哮喘护理系统（“青少年学校哮喘护理”; SBACT），并测试其在提高依从性和降低城市青少年发病率方面的有效性。 SB-ACT干预措施包括两个核心组成部分。首先，青少年在学年开始时每天访问学校护士，为期6-8周，以接受预防性哮喘药物的直接观察治疗（DOT）试验。目标是让青少年与护士建立关系，学习适当的用药技术，并体验日常预防治疗的好处和价值。DOT开始后4至6周，青少年将接受动机访谈（MI）咨询计划，旨在增强青少年过渡到独立，持续预防性药物使用的动机。我们将培训隶属于当地美国肺脏协会的社区护士，以提供MI组件。MI护士将在学校与青少年进行三次咨询会议，旨在利用青少年的DOT经验和他们所经历的潜在好处。考虑到这一人群中哮喘护理的复杂性，我们计划使用3组设计来评估这种干预，其中430名青少年将被随机分配到以下两组中：1）SB-ACT计划（DOT试验6-8周+3次MI咨询）; 2）仅DOT（DOT仅6-8周）;或3）哮喘教育（AE）对照组（由受过训练的哮喘教育者提供的校内哮喘教育）。我们包括DOT组，以评估单独使用这一成分是否足以促进持续的依从性，而无需咨询。AE组旨在加强哮喘护理和控制，以获得MI咨询的关注。我们将评估SB-ACT干预措施在降低哮喘发病率方面的有效性，进行经济可持续性分析，并评估计划实施的每个组成部分，重点是可持续性和传播。在研究完成后，将更好地确定这一以学校为基础的哮喘护理系统的有效性，作为改善青少年护理和减少健康差距的可持续手段。

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.