Enhancing Pediatric Asthma Management

描述(由申请人提供)： 国家心、肺和血液研究所(NHLBI)哮喘诊断和管理指南建议医生为持续性哮喘儿童每天开抗炎药物。指南特别将皮质类固醇描述为“治疗哮喘最有效和持续有效的长期控制药物”。然而，尽管NHLBI指南已经发布，但对于这些患者的医生处方来说，每日吸入皮质类固醇(DC)的效果有限。有有限的研究评估方法，以提高医生对NHLBI哮喘指南的依从性。我们将采用随机对照试验设计，评估屏障评估和多方面干预的效果，以改进儿科医生对持续性哮喘儿童的DC处方。我们开发了一个理论框架，描述了医生在遵守指南之前必须克服的障碍。在拟议项目的第一阶段，在22个初级保健儿科诊所，使用这个框架，我们将系统地评估给患有持续性哮喘的儿童开出DC的障碍。在项目的第二阶段，我们将评估在第一阶段障碍评估的基础上，以互动医生研讨会为特色的多方面干预是否可以向持续哮喘的儿科患者推广DC的医生处方。在三年的时间里，我们将使用图表审计、家长电话调查和医生调查来衡量儿科医生对DCS处方的知识、态度和实践的变化。预计与对照组的儿科医生相比，参加障碍评估和多层面教育研讨会的儿科医生对使用DCs的知识和态度将有所改善，并增加了对持续性哮喘患者的DCs处方。

DESCRIPTION (provided by the applicant): The National Heart, Lung, and Blood Institute (NHLBI) Guidelines for the Diagnosis and Management of Asthma recommend that practitioners prescribe daily anti-inflammatory medications for children with persistent asthma. The guidelines specifically describe corticosteroids as "the most potent and consistently effective long-term control medication for asthma". However, despite the publication of the NHLBI guidelines, there has been limited effect on physician prescription of daily-inhaled corticosteroids (DCS) for these patients. There are limited studies evaluating methods to improve physician adherence to the NHLBI asthma guidelines. Using a randomized controlled trial design, we will evaluate the effects of barrier assessment and a multi-faceted intervention to improve pediatrician prescription of DCS to children with persistent asthma. We have developed a theoretical framework that describes barriers that physicians must overcome before adhering to a guideline. In the first phase of the proposed project, at 22 primary care pediatric practices, using this framework, we will systematically assess barriers prescribing DCS to children with persistent asthma. In the second phase of the project, we will evaluate if a multi-faceted intervention featuring interactive physician seminars, based on the barrier assessment in the first phase can promote physician prescription of DCS to pediatric patients with persistent asthma. Over a three-year period, we will measure changes in pediatrician knowledge, attitudes and practice of DCS prescription using chart audits, parent telephone survey, and physician survey. It is expected that when compared to pediatricians in the control group, pediatricians who participate in the barrier assessment and multi-faceted educational seminars will have improved knowledge and attitudes towards the use of DCS, as well as increased prescription of DCS for their patients with persistent asthma.