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

项目摘要 背景几乎每一次因哮喘住院和死亡都可以通过适当的自我保护来预防。 管理然而，许多成年人患有不受控制的疾病，少数群体不成比例地 在该人群中，部分原因是吸入性皮质类固醇（ICS）的依从性较低。 关于哮喘及其药物治疗的个人信念有助于ICS不依从性。在我们早期 工作，我们开发并验证了一个简短的自我管理的工具，确定ICS的信念和哮喘 与哮喘不受控制相关的自我管理实践。当这些信息被分享时， 提供者开始与他们的病人谈论这些信念和实践。但我们不 我知道这些讨论是否能有效地让患者参与自我管理决策， 通过增加ICS的依从性来改善哮喘控制和生活质量（QoL）。目标：我们建议 针对城市少数族裔成年人调整并试行简短的循证、患者知情决策干预措施 无法控制的哮喘在初级保健和联邦合格的健康诊所接受治疗。方法：采用 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 接受常规哮喘治疗的患者。使用动机性面试技巧，PCP将参与 患者在健康和药物方面的自我管理决策方面享有更大的自主权 支持哮喘控制和生活质量的信念。我们的目标：目标1。评估干预是否 通过招募、随机化、保留、评估程序和实施来衡量的可行性 新的呼吸干预;目标2。评估干预是否为患者所接受 多变量线性混合模型将用于比较客户满意度的平均得分 调查-8次干预组调查。此外，试验后的嵌套定性访谈将提供以下数据： 可接受性;目标3.探索功效。虽然这项研究没有能力提供一个明确的测试， 组间结果的差异，我们将检查哮喘控制的组间差异， 在ICS中使用哮喘控制问卷，其中包括肺功能的生理指标， 使用与ICS客观指标相关的药物依从性量表-哮喘依从性 使用哮喘生活质量问卷，并注意建议的指导 和影响的大小，以规划未来的RCT。

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.