Telemedicine Enhanced Asthma Management - Uniting Providers for Teens (TEAM-UP for Teens)

远程医疗增强哮喘管理 - 联合青少年提供者 (TEAM-UP for Teens)

• 批准号: 10229607
• 负责人: Jill S Halterman
• 金额: $ 88.89万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-05 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10229607
• 关键词: Absenteeism; Adherence; Adolescent; Asthma; Caring; Cessation of life; Child; Clinical; Communities; Consultations; Control Groups; Counseling; Development; Directly Observed Therapy; Drug Prescriptions; Education; Effectiveness; Emergency Situation; Emergency department visit; Ensure; Guideline Adherence; Guidelines; Healthcare; Hospitalization; Hypersensitivity; Inflammation; Infrastructure; Intervention; Low income; Mediator of activation protein; Minority; Modeling; Morbidity - disease rate; Motivation; National Heart, Lung, and Blood Institute; Nurses; Outcome; Persons; Pharmaceutical Preparations; Population; Prevention; Preventive; Preventive care; Preventive therapy; Process; Process Measure; Provider; Public Health; Quality of life; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Regimen; Resources; Risk; Sampling; Schools; Self Management; Site; Specialist; Supervision; Symptoms; System; Technology; Teenagers; Telemedicine; Testing; Time; Urban Health; Visit; Visiting Nurse; Work; age group; base; care outcomes; care providers; comorbidity; compliance behavior; contextual factors; demographics; disparity reduction; effectiveness evaluation; elementary school; experience; follow-up; functional outcomes; high risk; implementation intervention; improved; improved outcome; innovation; intervention effect; medication compliance; motivational enhancement therapy; novel; optimal treatments; patient-clinician communication; primary outcome; programs; randomized trial; response; satisfaction; social factors; telehealth; treatment planning; urban children; virtual healthcare

Low-income, minority teenagers have disproportionately high rates of asthma morbidity, including excess risk of emergency department visits, hospitalizations, and death from asthma. Despite well established guidelines, under-treatment for asthma is common, particularly for poor urban teens. Our prior work has demonstrated that school-based directly observed therapy (DOT) of preventive asthma medications can improve outcomes for young, urban children with persistent asthma. We have also found that school-based telemedicine can effectively facilitate assessments by primary care providers (PCPs) for preventive medication prescriptions for DOT and for follow-up care. We recently conducted a study for teens with persistent asthma which included a trial of DOT of preventive medications at school paired with motivational interviewing (MI) counseling to promote independent adherence. While this program successfully improved medication adherence, it had a limited effect on asthma symptoms, and in particular many of the teens with moderate to severe persistent asthma at baseline continued to experience poor control despite the intervention. This was at least in part because for many of these teens, the medications initially prescribed for DOT were not optimally adjusted by PCPs and their asthma was undertreated. We realize that this program may be insufficient for these teens (>½ of the overall sample), since access to recommended specialist consultation for medication step-up or management of co-morbidities was not included. Further, while education and self-management support are critical for this age group, the MI counseling in this program required resources for several in-person visits. We now aim to test a novel, developmentally appropriate and scalable model of care to ensure optimal guideline- based treatment for urban teens with difficult to control asthma. The Telemedicine Enhanced Asthma Management-Uniting Providers for Teens (TEAM-UP Teens) program includes 3 core components: 1) An optimized asthma management plan developed at the start of the school year via a real-time, synchronous school-based telemedicine visit that directly connects the teen to an asthma specialist, 2) School-based DOT to implement the medication plan and allow for teens to experience the benefits of consistent therapy, 3) Follow-up telehealth visits with a nurse asthma educator to facilitate ongoing care and provide developmentally appropriate self-management support. In response to PA-18-722; Improving Patient Adherence to Treatment and Prevention Regimens, we propose a full-scale randomized trial of TEAM-UP for Teens vs an enhanced care (EC) control group (n=360, 12-16yrs). We will capitalize on the existing community infrastructure by implementing both telemedicine visits and DOT in schools. We will assess the effectiveness of TEAM-UP for Teens in reducing morbidity and improving guideline-based care (primary outcome: symptom-free days at 3, 6, 9, and 12 months) versus EC. At the study's completion, the program will be better defined as a sustainable means to improve care and reduce morbidity for high risk teens with moderate to severe persistent asthma.

低收入、少数族裔青少年的哮喘发病率异常高，包括过度风险 急诊就诊、住院治疗以及因哮喘死亡的情况。尽管制定了完善的指导方针， 哮喘治疗不足的情况很常见，特别是对于贫困的城市青少年而言。我们之前的工作已经证明 基于学校的预防性哮喘药物直接观察治疗 (DOT) 可以改善以下儿童的治疗结果 患有持续性哮喘的年轻城市儿童。我们还发现，基于学校的远程医疗可以 有效促进初级保健提供者（PCP）对预防性药物处方的评估 DOT 和后续护理。我们最近对患有持续性哮喘的青少年进行了一项研究，其中包括 在学校进行预防性药物 DOT 试验并结合动机访谈 (MI) 咨询 促进独立遵守。虽然该计划成功地提高了药物依从性，但它也有 对哮喘症状的影响有限，特别是对许多患有中度至重度持续性哮喘的青少年 尽管进行了干预，但基线哮喘仍控制不佳。这至少部分是 因为对于这些青少年中的许多人来说，最初为 DOT 开出的药物并没有经过最佳调整 PCP 及其哮喘治疗不足。我们意识到这个计划可能不足以满足这些青少年的需求（> ½ 总体样本），因为可以获得推荐的专家咨询以进行药物升级或 不包括合并症的管理。此外，虽然教育和自我管理支持 对于这个年龄段的人来说至关重要，该计划中的 MI 咨询需要资源来进行多次面对面的访问。我们 现在的目标是测试一种新颖的、适合发育和可扩展的护理模式，以确保最佳的指导方针- 针对难以控制哮喘的城市青少年的基础治疗。远程医疗增强哮喘治疗 青少年管理团结提供商 (TEAM-UP Teens) 计划包括 3 个核心组成部分：1) 通过实时、同步的方式在学年开始时制定优化的哮喘管理计划 学校远程医疗就诊，直接将青少年与哮喘专家联系起来，2) 学校 DOT 实施药物计划并让青少年体验持续治疗的好处，3) 与护士哮喘教育者进行后续远程医疗访问，以促进持续护理并提供发展服务 适当的自我管理支持。响应 PA-18-722；提高患者对治疗的依从性 和预防方案，我们提出了针对青少年的 TEAM-UP 与增强版的全面随机试验 护理 (EC) 对照组（n=360，12-16 岁）。我们将利用现有的社区基础设施 在学校实施远程医疗就诊和 DOT。我们将评估 TEAM-UP 的有效性 青少年降低发病率并改善基于指南的护理（主要结果：3、6、 9 个月和 12 个月）与 EC 相比。研究完成后，该计划将被更好地定义为可持续的 旨在改善患有中度至重度持续性哮喘的高危青少年的护理并降低发病率。