Self-care decision-making: Feasibility of the BREATHE asthma intervention trial

自我护理决策：BREATHE 哮喘干预试验的可行性

• 批准号: 9164685
• 负责人: MAUREEN GEORGE
• 金额: $ 25.53万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-26 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9164685
• 关键词: Adherence; Adoption; Adrenal Cortex Hormones; Adult; Advocate; Affect; Asthma; Belief; Breathing; Caring; Cessation of life; Chronic Disease; Client satisfaction; Clinic; Clinical; Communities; Complementary and alternative medicine; Data; Decision Making; Disease; Effectiveness; Evaluation; Federally Qualified Health Center; Focus Groups; Fostering; Future; Goals; Group Interviews; Health; Hospitalization; Hour; Insurance; Intervention; Intervention Trial; Interview; Measures; Mediation; Medical; Methods; Minority; Modeling; Office Visits; Outcome; Patients; Pharmaceutical Preparations; Physiological; Population; Primary Health Care; Procedures; Protocols documentation; Provider; Public Health; Qualifying; Quality of life; Questionnaires; Randomized; Recommendation; Recruitment Activity; Reporting; Respiratory physiology; Role; Self Care; Self Management; Self-Administered; Surveys; Techniques; Testing; Therapeutic; Therapeutic Intervention; Time; Work; base; brief intervention; community based participatory research; design; evidence base; group intervention; health belief; improved; instrument; literacy; medication compliance; motivational enhancement therapy; novel; patient oriented; prevent; screening; shared decision making; success; tool; treatment as usual

PROJECT SUMMARY Background. Nearly every hospitalization and death due to asthma could be prevented with appropriate self- management. However, many adults have uncontrolled disease and minorities are disproportionately represented within that population, due in part, to lower rates of inhaled corticosteroid (ICS) adherence. Personal beliefs about asthma and its pharmacologic treatment contribute to ICS non-adherence. In our earlier work, we developed and validated a brief self-administered instrument that identified ICS beliefs and asthma self-management practices associated with uncontrolled asthma. When this information was shared, their providers initiated conversations with their patients about these beliefs and practices. However, we do not know if these discussions are effective in engaging patients in self-management decision-making that would foster improved asthma control and quality of life (QoL) via increased ICS adherence. Goal: We propose to adapt and pilot a brief evidence-based patient-informed decision-making intervention with urban minority adults with uncontrolled asthma receiving care in primary care and federally qualified health clinics. Methods: Using community-based participatory research and a Patient Advisor on our study team, we will design and implement a feasibility trial of the Brief Evaluation of Asthma Therapy (BREATHE) as compared to usual care in patients receiving routine asthma care. Using motivational interviewing techniques, PCPs will engage patients to assume greater autonomy for self-management decision-making regarding health and medication beliefs that support asthma control and QoL. Our aims: Aim 1. To evaluate whether the intervention is feasible as measured by recruitment, randomization, retention, assessment procedures, and implementation of the novel BREATHE intervention; Aim 2. To evaluate whether the intervention is acceptable to patients and PCPs a multivariable linear mixed model will be used to compare the mean score of the Client Satisfaction Survey-8 across intervention groups. In addition, nested qualitative interviews, post-trial, will provide data on acceptability; Aim 3. Exploration of efficacy. While the study is not powered to provide a definitive test of differences in outcomes between the groups, we will examine differences across groups in asthma control, using the Asthma Control Questionnaire which includes a physiologic measure of lung function, in ICS adherence using the Medication Adherence Scale-Asthma which correlates with objective measures of ICS use and in asthma QoL using the Asthma Quality of Life Questionnaire, taking note of the suggested direction and magnitude of the effects for planning a future RCT.

项目概要 背景。通过适当的自我预防，几乎所有因哮喘而导致的住院和死亡都是可以预防的。 管理。然而，许多成年人患有不受控制的疾病，少数族裔则不成比例地患有这种疾病。 部分原因是吸入皮质类固醇（ICS）依从率较低。 对哮喘及其药物治疗的个人信念导致 ICS 不依从。在我们之前的 在工作中，我们开发并验证了一个简短的自我管理工具，可以识别 ICS 信念和哮喘 与不受控制的哮喘相关的自我管理实践。当这些信息被分享时，他们 提供者与患者就这些信念和做法展开对话。然而，我们不 了解这些讨论是否能有效地让患者参与自我管理决策，从而 通过增加 ICS 依从性，促进改善哮喘控制和生活质量 (QoL)。目标：我们建议 对城市少数民族成年人进行简短的基于证据的患者知情决策干预并试点 患有不受控制的哮喘，在初级保健机构和联邦合格的健康诊所接受护理。方法：使用 基于社区的参与性研究和我们研究团队的患者顾问，我们将设计和 与常规护理相比，实施哮喘治疗简要评估 (BREATHE) 的可行性试验 接受常规哮喘护理的患者。使用动机访谈技术，PCP 将参与 患者在健康和药物方面的自我管理决策方面拥有更大的自主权 支持哮喘控制和生活质量的信念。我们的目标： 目标 1. 评估干预措施是否有效 通过招募、随机化、保留、评估程序和实施来衡量可行 新颖的呼吸干预措施；目标 2. 评估患者是否可以接受干预措施 和 PCP 的多变量线性混合模型将用于比较客户满意度的平均得分 跨干预组的调查 8。此外，审判后的嵌套定性访谈将提供以下数据： 可接受性；目标 3. 功效探索。虽然该研究无法提供明确的测试 各组之间结果的差异，我们将检查各组哮喘控制的差异， 在 ICS 中使用哮喘控制问卷，其中包括肺功能的生理测量 使用药物依从性量表-哮喘的依从性，该量表与 ICS 的客观测量相关 使用哮喘生活质量问卷在哮喘 QoL 中使用，并注意建议的方向 以及规划未来 RCT 的影响程度。