Telecommunications Enhanced Asthma Management (TEAM)

描述(由申请人提供)：我们提出了一项实用的随机临床试验，以测试健康沟通干预的影响，该干预旨在改善科罗拉多州最大的健康维护组织科罗拉多州凯撒永久医院(KPCO)3-12岁哮喘儿童对吸入性哮喘控制器用药的依从性。电信增强型依从性管理(Team)干预旨在通过使用自动电信技术加强与儿科患者及其父母的沟通和支持：1)使父母能够更容易地接触到照顾者；2)提供立即请求续药和询问孩子症状的机会；3)提供关于儿童每日哮喘药物重要性的教育和激励信息。这种健康交流干预将通过最先进的语音识别(SR)技术提供。SR技术的进步使计算机生成的对话更容易被受访者接受，并允许正确解读父母的口头反应，进而产生一系列适当的SR反应。调查团队拥有使用自动化电信技术促进健康行为改变的丰富经验。利益-风险模型和社会营销理论继续指导着干预的目标和过程。前景理论是对这些的补充，并将指导SR干预中包含的激励信息的发展。这将是一项针对接受吸入性皮质类固醇(ICS)治疗哮喘的儿童的kpco父母的全部人群的实用临床试验。预计为期12个月的小组干预将增加ICS的充填持久性和药物依从性(主要结果)，足以在与常规护理对照组相比，在哮喘相关的健康结果方面产生显著改善，如紧急护理就诊频率、泼尼松的使用、β2激动剂的使用以及父母报告的症状控制和生活质量(次要结果)。一项子研究将在参与团队干预之前和之后随机抽样200个家庭，以收集有关可能影响干预有效性的变量的信息，这些变量包括种族、社会经济地位、疾病严重程度、家庭结构和受益-风险认知。处方补给是依从性的准确衡量这一假设将在第二项子研究中进行测试，该研究将使用电子设备来跟踪ICS的依从性。这种基于系统的干预是使用RE-AIM框架设计的，因此它应该具有很高的覆盖率，并以较低的成本持续实施，如果有效，它可以在KPCO内维护，也可以很容易地输出到其他临床保健环境

DESCRIPTION (provided by applicant): We propose a practical, randomized clinical trial to test the impact of a health communication intervention designed to improve inhaled asthma controller medication adherence in 3-12 year old children with asthma in Kaiser Permanente of Colorado (KPCO), the largest health maintenance organization in the state. The Telecommunication Enhanced Adherence Management (TEAM) intervention is designed to increase communication with and support of pediatric patients and their parents by using automated telecommunication technology to: 1) allow parents more easy access to caregivers, 2) provide an immediate opportunity to request refills and inquire about their child's symptoms, and 3) provide educational and motivating messages about the importance of the child's daily asthma medication. This health- communication intervention will be delivered through state-of-the-art speech recognition (SR) technology. Advances in SR technology have made computer-generated conversation easier and more acceptable to respondents, and allow for correct interpretation of parents' spoken responses that in turn can lead to a range of appropriate SR responses. The investigative team has extensive experience using automated telecommunication technology to promote health-enhancing behavior change. The Benefit-Risk Model and Social Marketing Theory continue to guide both the objective and process of the intervention. Prospect Theory complements these and will guide development of the motivating messages to be contained in the SR intervention. This will be a Practical Clinical Trial aimed at the entire population of KPCO parents of a child receiving an inhaled corticosteroid (ICS) for asthma. It is expected that the 12-month TEAM intervention will increase ICS refill persistence and medication adherence (primary outcome) sufficient to produce significant improvement, relative to the usual-care control group, in asthma-related health outcomes as reflected in frequency of urgent care visits, prednisone use, beta2agonist use, and parent-reported symptom control and quality of life (secondary outcomes). A sub-study will randomly sample 200 families, both before and after participation in the TEAM intervention, to gather information about variables that may moderate the effectiveness of the intervention including race, socioeconomic status, illness severity, family structure, and benefit-risk perception. The presumption that prescription refilling is an accurate measure of adherence will be tested in a second sub-study that will use electronic devices to track ICS adherence. This system- based intervention has been designed using the RE-AIM framework so that it should have high reach and be consistently implemented at modest cost, and if effective, it can be maintained within KPCO as well as readily exported to other clinical healthcare settings