Improving Asthma Communication in Minority Families

描述(由申请人提供)：有频繁急诊科(ED)护理和住院病史的儿童哮喘发病率增加的风险最大，包括生活质量下降、缺课增加和危及生命的哮喘。治疗儿童哮喘的护理费用很高。父母和孩子有能力将症状准确地传达给医生，这对于最佳的哮喘诊断和治疗至关重要。当与及时和适当的哮喘药物使用联系在一起时，准确的医生-父母-儿童沟通可能会降低哮喘发病率。据报道，市中心儿童早期自行使用吸入性哮喘药物的平均年龄为8岁。尽管哮喘患者的自我管理能力还很小，但很少有研究关注孩子在就医过程中的作用。这项研究旨在确定父母和儿童哮喘沟通干预(ACI)是否与目标1：增强父母和孩子的沟通技能、目标2：降低哮喘发病率、目标3：根据药房的补充率加强对哮喘药物的适当依从性以及目标4：与参加标准哮喘教育干预(SAE)的儿童相比证明成本效益。比较两组(ACI组和SAE组)在18个月随访期间急诊次数、住院日数、急诊次数、初级护理次数、缺课次数、限制活动次数、症状日夜数、功能状态、生活质量等方面的差异。马里兰大学医院儿科急诊科、住院病房和社区儿科诊所将作为我们的招聘地点。将纳入6-12岁(N=220)的轻度至重度持续性哮喘儿童家庭。数据分析将包括卡方检验、t检验、方差分析和多元线性回归模型。将使用广义估计方程(GEE)来处理重复测量之间的相关性。将产生成本效益和成本效益比率，以检查不同群体之间护理成本的差异。研究结果将提供有关哮喘沟通干预对轻度至重度持续性哮喘儿童的效果、干预的相对成本以及满足轻度至重度哮喘儿童需求所需的主要组成部分的重要数据。研究结果将改善对这一弱势儿童群体以及患有其他慢性病的儿童的临床护理，将对卫生保健提供者、研究人员、保险公司和政策制定者有重大帮助，并将具有重大的公共卫生适用性。

DESCRIPTION (provided by applicant): Children with a history of frequent emergency department (ED) care and hospitalizations are at the greatest risk for increased asthma morbidity including decreased quality of life, increased school absences and life threatening asthma. Cost of care in treating pediatric asthma is high. Parental and child ability to accurately communicate symptoms to the physician is critical for optimal asthma diagnosis and treatment. When linked to timely and appropriate asthma medication use, accurate physician-parent-child communication may result in decreased asthma morbidity. Early self-administration of inhaled asthma medications was reported at a mean age of 8 years for inner-city children. Despite this early age of asthma self-management, little research focuses on the child's contribution to the medical encounter. This study is designed to determine if a parent and child asthma communication intervention (ACI) will be associated with AIM 1:enhanced communication skills of the parent and child, AIM 2:reduced asthma morbidity, AIM 3: enhanced appropriate adherence to asthma medication based on pharmacy refill rates and AIM 4: demonstrate cost effectiveness as compared to children enrolled in a standard asthma education intervention (SAE). Differences in ED visits for asthma, hospital days, number of urgent and primary care visits, school absences, restricted activity, number of symptom days and nights, functional status, quality of life over the 18 month follow-up will be compared between the two groups (ACI and SAE). The University of Maryland Hospital Pediatric ED, inpatient unit and Community pediatric clinics will serve as our recruitment sites. Families of children with mild-severe persistent asthma ages 6-12 years (N=220) will be enrolled. Data analysis will include chi-square, t-tests, ANOVA and multivariate linear regression models. The Generalized Estimating Equation (GEE) will be used to address the correlation of repeated measures. Cost-effectiveness and cost benefit ratios will be generated to examine for differences in cost of care between groups. Study outcomes will provide important data on the effects of an asthma communication intervention for children with mild to severe persistent asthma, the relative cost of the intervention; and the major components required to meet the needs of children with mild to severe asthma. Study findings will improve clinical care to this vulnerable population of children as well as children with other chronic illness and will be of significant use to health care providers, researchers, insurers and policy makers and will have significant public health applicability.