Family Routines & Medical Adherence in Children with Asthma: A Tailored Intervent

描述（由申请人提供）：本提案是对PA-07-099儿童和青少年慢性疾病自我管理的回应。提出了一项试点干预措施，以提高自我管理和生活质量的青少年哮喘。不良的哮喘管理措施每年造成32亿美元的卫生保健费用。不遵守处方方案的情况很高，只有不到一半的儿童遵守医嘱。R21的结果将为一项完整的随机临床试验提供信息，所采用的方法可能适用于其他慢性疾病，如糖尿病和囊性纤维化。通过注重医疗依从性、家庭功能和量身定制的干预措施，实现了方案的目标。该提案旨在通过建立日常生活，影响父母和孩子之间的直接沟通，减少照顾的情感负担，改善以家庭为基础的管理策略。首先，将对30,8 -12岁患有持续性哮喘的儿童及其主要照顾者进行一系列焦点小组调查。在另一项美国国立卫生研究院的研究中，200个家庭提出了哮喘管理策略的有用提示。这些提示是家庭日常生活的一部分，旨在提高医疗依从性。护理人员和儿童将完成对每个例行程序的可接受性评分，并讨论坚持医疗方案的障碍。根据可接受度评分和焦点小组讨论，将确定一套常规程序，以便在初级保健环境中进行量身定制的干预。其次，30名8至12岁的持续性哮喘儿童及其护理人员将被纳入干预组。药物依从性的基线记录将被记录4周，然后在初级保健访问期间与呼吸治疗师一起与儿童和家长进行审查。孩子和照顾者将会收到一份从焦点小组中提取的日常活动菜单（例如，使用日历，用牙刷放置药物，计划过夜），并被要求选择最适合他们自己的障碍和家庭生活的六个。代表这些日常活动的卡片或物品将被放在一个家庭背包里，让孩子带回家。对照组30名哮喘患儿将接受呼吸治疗师的标准哮喘教育。三个月和六个月的随访将用于比较两组药物依从性、生活质量和自我效能的水平。该项目的结果将用于在初级保健机构开展大规模随机临床试验，为不同人群的持续性哮喘儿童提供服务。7.

DESCRIPTION (provided by applicant): This proposal is in response to PA-07-099 Chronic Illness Self-Management in Children and Adolescents. A pilot intervention is proposed to improve self-management and quality of life of youth with asthma. Poor asthma management practices cost 3.2 billion dollars per year in health care costs. Non-adherence to prescribed protocols is high, with less than half of children following physician's orders. The results of this R21 will inform a full randomized clinical trial and the methodology employed may be applicable to other chronic health conditions such as diabetes and cystic fibrosis. The objectives of the PA are fulfilled by focusing on medical adherence, family functioning, and tailored interventions. The proposal aims to improve family based management strategies by building on daily routines, effecting direct communication between parent and child, and reducing emotional burden of care. First, a series of focus groups will be conducted with 30, 8-12 year old children with persistent asthma and their primary caregivers. Families will be presented a collection of helpful hints of asthma management strategies suggested by 200 families in another NIH study. The hints are framed as part of the family's daily routines and are geared to improve medical adherence. The caregivers and children will complete ratings of acceptability for each of the routines and discuss barriers in adhering to medical regimens. Based on the acceptability ratings and focus group discussions, a set of routines will be identified for a tailored intervention in a primary care setting. Second, 30 children between 8 and 12 years old with persistent asthma and their caregivers will be enrolled in an intervention group. Baseline recordings of medication adherence will be taken for 4 weeks and then reviewed with the child and parent during a primary care visit with a respiratory therapist. The child and caregiver will be presented a menu of routines drawn from the focus group (e.g., using calendars, placing medications by tooth brush, planning for sleepovers) and asked to select six that will fit best with their own barriers and family life. Cards or objects representing the routines will be placed in a Family Backpack for the child to take home. A control group of 30 children with asthma will receive standard asthma education from the respiratory therapist. Three- and six-month follow up will be used to compare the groups on levels of medication adherence, quality of life, and self efficacy. Results of the project will be used to develop a large scale randomized clinical trial in primary care settings serving diverse populations of children with persistent asthma. 7. PUBLIC HEALTH RELEVANCE: Of the nine million children in the United States that were affected by asthma in 2002, four million had an asthma attack and close to one million were seen in emergency departments, while over $3 billion was spent in asthma care. Asthma is a controllable condition and adherence to prescribed medications can reduce expensive health care costs and reduce the number of school days missed due to asthma. This tailored yet practical and feasible intervention aims to increase medical adherence by building on family routines that will make it easier to remember to take daily medications.