IMPROVING QUALITY OF LIFE OUTCOMES IN ASTHMA PATIENTS

正如《2000年健康人指南》所概述的那样，一项重要的国家卫生目标，特别是对于服务不足的人群，是保持哮喘患者的功能状态。本随机对照试验的目的是评估包括教育、增强自我效能和电话社会支持在内的干预措施在保持和改善180例不同社会人口背景的中度哮喘患者的功能状态方面的有效性。我们的目标也是设计干预措施，以便在日常办公实践中易于实施和加强。我们的假设是：1)提高自我效能感、社会支持和哮喘教育的干预对维持和改善2年的功能状态更有效；2)抑郁症状加重、合并症增多、哮喘护理机会减少与一般自我效能感和哮喘自我效能感降低相关；3)关于哮喘的教育将增加对哮喘的知识和正确的信念，对哮喘的现实期望，以及对哮喘状况和治疗的更高满意度；4)自我效能感更高，社会支持更多，哮喘教育更多的患者将减少住院，急诊室就诊和紧急就诊。对于对照组和实验组，干预措施将包括向医生传播NHLBI专家小组关于医生提供的患者教育和自我指导的NHLBI患者哮喘工作手册的建议。实验组还将接受量身定制的干预，以提高哮喘自我效能，通过与研究人员的电话联系获得哮喘社会支持，以及亲自加强或“助推器”干预。主要结果将是患者在入组后2年哮喘生活质量问卷活动领域的变化。额外的结果将是通过测量2年后患者体内功能状态的变化（包括身体功能域和SF-36的堆肥物理评分）来评估干预的有效性，并通过根据住院、急诊室就诊和紧急医生办公室就诊来测量2年内哮喘的资源利用率来评估干预的有效性。长期目标是证明建立在已经建立的有效干预措施基础上的干预措施可以在日常实践中容易实施和加强，并且可以促进哮喘患者的功能改善。

As outlined in the Healthy People 2000 guidelines, an important national health objective, especially for underserved populations, is to preserve functional status in patients with asthma. The goal of this randomized control trial is to assess the effectiveness of an intervention involving education, enhancement of self-efficacy, and telephone social support in preserving and improving functional status in 180 patients from diverse socio-demographic backgrounds with moderate asthma. The goal is also to design the intervention so that it is easy to implement and reinforce in day-to-day office practice. The hypotheses are that: 1) an intervention to increase self-efficacy, social support, and asthma education will be more effective in preserving and improving functional status over 2 years; 2) greater depressive symptoms, more comorbidity, and less access to asthma care will be associated with lower general self-efficacy and asthma self-efficacy; 3) education about asthma will result in increased knowledge and correct beliefs about asthma, realistic expectations about asthma, and greater satisfaction with asthma status and treatment, and 4) patients with higher self-efficacy, greater social support, and more education about asthma will have fewer hospitalizations, emergency room visits, and urgent doctor's office visits. For both control and experimental groups the intervention will involve dissemination to physicians of NHLBI Expert Panel recommendations for physician-provided patient education and a self-directed NHLBI patient asthma workbook. The experimental group also will receive a tailored intervention to increase asthma self-efficacy, asthma social support through telephone contact with study personnel, and in-person reinforcements or "boosters" of the interventions. The main outcome will be within-patient change in the Activities domain of the Asthma Quality of Life Questionnaire at 2 years after enrollment. Additional outcomes will be to assess the effectiveness of the intervention by measuring within-patient change in functional status after 2 years with the physical function domain and the compost physical score of the SF-36, and to assess the effectiveness of the intervention by measuring resource utilization due to asthma over 2 years according to hospitalizations, emergency room visits, and urgent doctor office visits. The long-term objectives are to demonstrate that an intervention that builds on already established effective interventions can be easily administered and reinforced in daily practice and can promote functional improvement in patients with asthma.