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: 10678849
• 负责人: Jill S Halterman
• 金额: $ 89.12万
• 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/10678849
• 关键词: Absenteeism; Adherence; Adolescent; Asthma; Caring; Cessation of life; Child; 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; Managed Care; Mediator; Minority; Modeling; Morbidity - disease rate; Motivation; National Heart, Lung, and Blood Institute; Nurses; Outcome; Patients; 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; Recommendation; Regimen; Resources; Risk; Sampling; Schools; Self Management; Site; Specialist; Symptoms; System; Technology; Teenagers; Telemedicine; Testing; Time; Urban Health; Visit; Visiting Nurse; Work; age group; care outcomes; clinical outcome assessment; comorbidity; compliance behavior; contextual factors; demographics; disparity reduction; effectiveness evaluation; elementary school; enhanced care; experience; follow-up; functional outcomes; high risk; implementation intervention; improved; improved outcome; innovation; intervention effect; medication compliance; motivational enhancement therapy; novel; optimal treatments; primary care provider; primary outcome; programs; provider communication; 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，少数民族青少年有不成比例的哮喘发病率高，包括过度风险 急诊室就诊、住院和哮喘死亡的风险。尽管有既定的指导方针， 对哮喘治疗不足的现象很普遍，特别是对贫穷的城市青少年而言。我们之前的工作已经证明， 以学校为基础的预防性哮喘药物的直接观察治疗（DOT）可以改善 患有持续性哮喘的城市儿童我们还发现，以学校为基础的远程医疗可以 有效地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， 在学校进行预防药物DOT试验，并结合动机访谈（MI）咨询， 促进独立坚持。虽然该计划成功地提高了药物依从性，但它有一个 对哮喘症状的影响有限，特别是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，但基线时的哮喘仍然控制不佳。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开出的药物并没有得到最佳调整， PCP和他们的哮喘治疗不足。我们意识到，这个计划可能不足以为这些青少年（> 1/2 总体样本的百分比），因为获得了推荐的专家咨询，以逐步增加药物治疗或 不包括合并症的管理。此外，虽然教育和自我管理支助是 对于这一年龄组至关重要，该计划中的MI咨询需要资源进行多次面对面访问。我们 现在的目标是测试一种新的，发展适当的和可扩展的护理模式，以确保最佳的指导方针- 为难以控制哮喘的城市青少年提供基础治疗。远程医疗增强哮喘 管理团结供应商为青少年（团队青少年）计划包括3个核心组成部分：1）一个 优化哮喘管理计划在学年开始时通过实时，同步 以学校为基础的远程医疗访问，直接将青少年与哮喘专家联系起来，2）以学校为基础的DOT 实施药物治疗计划，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保健访问，以促进持续护理并提供发育性 适当的自我管理支持。对PA-18-722的回复;改善患者对治疗的依从性 和预防方案，我们提出了一个全面的随机试验的团队，对青少年与增强 护理（EC）对照组（n=360，12- 16岁）。我们会善用现有的社区基础设施， 在学校实施远程医疗访问和DOT。我们将评估团队合作的有效性， 青少年在降低发病率和改善基于指南的护理（主要结局：3，6， 9和12个月）与EC相比。在研究完成后，该计划将被更好地定义为一个可持续的 改善中度至重度持续性哮喘高危青少年的护理和降低发病率的方法。