ED-Initiated School-based Asthma Medication Supervision (ED-SAMS)

项目摘要 哮喘在儿童中引起相当大的发病率，其中大部分可归因于药物治疗， 坚持。以学校为基础的每日吸入性皮质类固醇（ICS）治疗的监督增加了药物治疗 坚持并减少哮喘控制不良的发作。然而，从学校招收儿童， 许多患有轻度哮喘和不经常使用医疗保健的儿童。因此，启动监督治疗 这些孩子往往会降低该计划的成本效益。为了解决这一效率低下的问题，我们建议 通过招募从学校毕业的儿童， 哮喘发作治疗后的急诊科（艾德）。虽然指南建议艾德临床医生 考虑在出院时开始ICS治疗，<20%的儿童在接受以下治疗后从艾德出院 哮喘病发作时接受控制器治疗的处方。数据表明，使用ICS的患者， 出院后再次艾德就诊的可能性是非使用者的一半。然而，仅仅为患者提供 处方并不能确保他们在出院后会一直服用。为了确保访问和 为了确保学生能坚持使用控制药物，我们建议在出院时分发ICS，并监督其在学校的使用。 我们建议在儿科急救护理应用研究网络内进行试点 临床试验，目的如下：目的1.确定分配吸入的可行性和可接受性 在急诊科使用皮质类固醇，并监督其在学校环境中的使用。艾德之后 哮喘发作的管理，轻度至中度哮喘的小学年龄儿童随机分配到 ED-SAMS方案将规定每天一次布地奈德吸入功率作为学校进行监督。目的 2.估计一系列合理的干预效应量，以支持开发更大的多变量模型。 中心临床试验。来自3个ED的90名儿童将随机接受ICS处方， 使用（对照）或ICS分发用于家庭和学校使用（干预）。主要结果将是90- 白天艾德累犯。目标3。进行初步的成本效益分析。我们将估计干预 成本，以确定干预措施在合理效果范围内具有成本效益的概率 尺寸.成功完成这项试点试验将支持开展一项更大规模的多中心试验， 确定干预是否具有成本效益地降低了小学年龄儿童的急性加重风险 患有轻度到中度哮喘

PROJECT SUMMARY Asthma causes substantial morbidity among children and much of it is attributable to medication non- adherence. School-based supervision of daily inhaled corticosteroid (ICS) treatment increases medication adherence and reduces episodes of poor asthma control. However, recruiting children from schools enrolls many children with mild asthma and infrequent health care use. Therefore, initiating supervised treatment for these children tends to diminish the program's cost-effectiveness. To address this inefficiency, we propose to target children who are at high risk of poor outcomes by recruiting children who are discharged from the emergency department (ED) following treatment of an asthma attack. While guidelines recommend ED clinicians consider initiating ICS treatment at discharge, <20% of children discharged from the ED following treatment for an asthma attack receive a prescription for controller therapy. Data indicates that patients who use ICS following discharge are half as likely as non-users to experience a repeat ED visit. However, simply providing patients with a prescription does not ensure that they will fill it and use it consistently once discharged. To ensure access and adherence to controller medication, we propose to dispense ICS at discharge and supervise its use at school. We propose to work within the Pediatric Emergency Care Applied Research Network to conduct a pilot clinical trial with the following aims: Aim 1. Determine the feasibility and acceptability of dispensing inhaled corticosteroids in the emergency department and supervising its use in the school setting. Following ED management of an asthma attack, elementary-age children with mild-to-moderate asthma randomized to the ED-SAMS program will be prescribed once-daily budesonide inhalation power to be supervised as school. Aim 2. Estimate a range of plausible intervention effect sizes to support the development of a larger multi- center clinical trial. Ninety children from 3 EDs will be randomized to receive an ICS prescription for at-home use (control) or ICS dispensing for at-home and at-school use (intervention). The primary outcome will be 90- day ED recidivism. Aim 3. Conduct a preliminary cost-effectiveness analysis. We will estimate intervention costs to determine the probability that the intervention could be cost-effective within a range of plausible effect sizes. Successful completion of this pilot trial will support the development of a larger multicenter trial to determine whether the intervention cost-effectively reduces exacerbation risk among elementary-age children with mild-to-moderate asthma.