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.

低收入的少数族裔青少年哮喘发病率高得不成比例，包括风险过高。 急诊科就诊、住院治疗和哮喘死亡。尽管制定了完善的指导方针， 哮喘治疗不足是很常见的，特别是对贫穷的城市青少年。我们之前的工作已经证明了 预防哮喘药物的学校直接观察疗法(DOT)可以改善 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)评估预防性药物处方 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 学校预防药物DOT结合动机访谈(MI)咨询的试验 促进自主坚持。虽然这项计划成功地改善了服药依从性，但它也有 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 尽管采取了干预措施，基线水平的哮喘仍未得到有效控制。这至少是部分原因 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优化调整 PCP和他们的哮喘没有得到充分的治疗。我们意识到，该计划可能不足以满足这些青少年的需求 总体样本)，因为可以获得推荐的专家会诊以进行用药步骤或 合并症的管理不包括在内。此外，虽然教育和自我管理支持是 对于这个年龄段来说至关重要的是，这个项目中的MI咨询需要几次面对面访问的资源。我们 现在的目标是测试一种新的、适合发展的和可扩展的护理模式，以确保最佳指南- 为难以控制哮喘的城市青少年提供基础治疗。远程医疗增强的哮喘 管理-青少年联合提供者(Team-up Teens)计划包括3个核心组成部分：1)和 在学年开始时通过实时、同步的 基于学校的远程医疗访问，直接将青少年与哮喘专家联系起来，2)基于学校的DOT 实施药物治疗计划，让青少年体验到持续治疗的好处，3) 与哮喘教育护士一起跟踪远程健康访问，以促进持续护理和提供发育方面的 适当的自我管理支持。对PA-18-722的回应；提高患者对治疗的依从性 和预防方案，我们提出了一项针对青少年的全面随机试验VS增强版 CARE(EC)对照组(n=360，12~16岁)。我们将利用现有的社区基础设施，通过 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以指南为基础的护理方面的进展(主要结果：3、6、 9个月和12个月)与EC。在研究完成后，该计划将被更好地定义为可持续的 改善对患有中度到重度持续性哮喘的高危青少年的护理和降低发病率的手段。