哮喘联盟

   摘要
   老年哮喘患者在有效的自我管理和哮喘控制方面面临着许多障碍，其预后要差于年轻哮喘患者。然而，并没有关于旨在改善他们的护理与预后的干预措施的对照试验。通过多方利益相关者（患者、学术界、以社区为基础的组织、国家卫生署和倡导组织）的合作，我们制定了一项多组分哮喘自我管理支持干预措施，以改善60岁及以上患者的各种社会心理、功能性、健康状况、和有效哮喘自我管理的认知障碍。我们在曼哈顿和布朗克斯招募了425位纽约人，开展了一项实用的随机对照试验。该试验的干预措施在三个地方进行，分别是基层医疗单位、家里或常规治疗场所。在干预过程中，护理教练使用一种新型的筛选工具来识别他们实现哮喘控制和自我管理的特定障碍。一旦识别出来，教练和患者就会从操作菜单中选择一项去解决它。此项干预措施强调了效率、灵活性、共享决策、目标设定、沟通策略（适用于认识和读写技能存在局限的个体）和持续性强化与支持。此外，我们引进了所有参与临床实践者电子健康记录的哮喘特异增强功能，包括哮喘严重程度评估、临床决策支持和为患者量身定做的哮喘行动计划。对患者进行为期12个月的随访，在基线、3个月、6个月和12个月时对患者进行询问。急诊就诊和住院的数据通过纽约全州规划和研究协作系统获得。
 

（杨冬 审校）
ContempClinTrials. 2015Jul31.pii:S1551-7144(15)30055-0.doi:10.1016/j.cct.2015.07.018. [Epub ahead of print]


 

Rationale and design of a comparative effectiveness trial of home- and clinic-based self-management support coaching for older adults with asthma.
 

Federman AD1, Martynenko M2, O'Conor R3, Kannry J2, Karp A2, Lurio J4, Hoy-Rosas J5, Lopez R6, Obiapi R7,Young E8, Wolf MS3, Wisnivesky JP9; SAMBA Investigators.

Collaborators (27)
 

Abstract
Older adults with asthma face numerous barriers to effective self-management and asthma control, and experience worse outcomes than younger asthmatics. Yet, there have been no controlled trials of interventions specifically designed to improve their care and outcomes. Through a multi-stakeholder collaboration (patients, academia, community-based organizations, a state department of health, and an advocacy organization) we developed a multi-component asthma self-management support intervention to address the myriad psychosocial, functional, health status, and cognitive barriers to effective asthma self-management in adults ages 60 and older. We are recruiting 425 New Yorkers in Manhattan and the Bronx for a pragmatic randomized controlled trial with 3 arms: the intervention delivered in primary care settings or in their home, or usual care. In the intervention, care coaches use a novel screening tool to identify the specific barriers to asthma control and self-management they experience. Once identified, the coach and patient choose from a menu of actions to address it. The intervention emphasizes efficiency, flexibility, shared decision making and goal setting, communication strategies appropriate for individuals with limited cognition and literacy skills, and ongoing reinforcement and support. Additionally, we introduced asthma-specific enhancements to the electronic health records of all participating clinical practices, including an asthma severity assessment, clinical decision support, and a patient-tailored asthma action plan. Patients will be followed for 12months and interviewed at baseline, 3, 6, and 12months and data on emergency department visits and hospitalizations will be obtained through the New York State Statewide Planning and Research Cooperative System.
 

ContempClinTrials. 2015Jul31.pii:S1551-7144(15)30055-0.doi:10.1016/j.cct.2015.07.018. [Epub ahead of print]