在乡村学校通过远程医疗进行的哮喘教育项目结果
2018/05/03
摘要
背景：美国乡村地区低收入家庭孩子的哮喘发病率居高不下，然而目前鲜有针对减少乡村人口哮喘负担的干预措施。
目的：调查通过远程医疗提供的以学校为基础的哮喘教育计划对生活在贫困农村地区的儿童的影响。
方法：我们对7-14岁的农村儿童进行了一项集簇的随机试验，比较了一个以学校为基础的远程医疗哮喘教育干预与常规护理的差异。干预措施通过远程医疗为受试者提供了全面的哮喘教育，并向初级保健医护者提供了循证医学的治疗建议。
结果：入组393名儿童，平均年龄为9.6岁，其中有81%的患儿是非裔美国人，47%的患儿生活在年收入小于14999美元的家庭中。有88%的患儿报告有未控制的哮喘症状。在干预结束时，干预组与常规护理组间，报告的无症状天数（主要结局）无显著统计学差异。干预组的受试者报告，应用峰流速仪监测哮喘及应用哮喘处方药物，均显著高于常规护理组。其他结局指标，包括生活质量，自我效能感，哮喘知识，或肺功能在组间没有差异。
结论：尽管在对受试者进行干预时有一些行为改变的证据，但这些改变不足以克服症状重的农村贫困人口的高发病率。未来的干预措施应该采用多方面设计，兼顾到监护人的参与，地理位置的问题以及农村地区哮喘患者的接触不足等。
Results of an asthma education program delivered via telemedicine in rural schools.
Tamara T. Perry，et al.
Abstract
BACKGROUND：Asthma morbidity is high among low-income children living in rural U.S. regions, yet few interventions have been designed to reduce asthma burden among rural populations.
OBJECTIVE：Examine the impact of a school-based asthma education program delivered via telemedicine among children living in an impoverished, rural region.
METHODS：We conducted a cluster randomized trial with rural children, ages 7-14 years, comparing a school-based telemedicine asthma education intervention to usual care. The intervention provided comprehensive asthma education via telemedicine to participants and provided evidence-based treatment recommendations to primary care providers.
RESULTS：Of the 393 enrolled children, median age was 9.6 years, 81% were African-American and 47% lived in households with <$14,999 annual income. At enrollment, 88% of children reported uncontrolled asthma symptoms. At the end of the intervention, there were no statistically significant differences in reported symptom free days (primary outcome) for either the intervention or usual care group. Participants in the
intervention group reported significantly higher utilization of peak flow meters to monitor asthma and reported taking their asthma medications as prescribed more frequently when compared to the usual care group. There were no changes in other outcome measures including quality of life, self-efficacy, asthma knowledge, or lung function between groups.
CONCLUSION：Although there was some evidence of behavior change among intervention participants, these changes were inadequate to overcome the significant morbidity experienced by this highly symptomatic rural, impoverished population. Future interventions should be designed with a multifaceted approach that considers caregiver engagement, distance barriers and inadequate access to asthma providers in rural regions.
背景：美国乡村地区低收入家庭孩子的哮喘发病率居高不下，然而目前鲜有针对减少乡村人口哮喘负担的干预措施。
目的：调查通过远程医疗提供的以学校为基础的哮喘教育计划对生活在贫困农村地区的儿童的影响。
方法：我们对7-14岁的农村儿童进行了一项集簇的随机试验，比较了一个以学校为基础的远程医疗哮喘教育干预与常规护理的差异。干预措施通过远程医疗为受试者提供了全面的哮喘教育，并向初级保健医护者提供了循证医学的治疗建议。
结果：入组393名儿童，平均年龄为9.6岁，其中有81%的患儿是非裔美国人，47%的患儿生活在年收入小于14999美元的家庭中。有88%的患儿报告有未控制的哮喘症状。在干预结束时，干预组与常规护理组间，报告的无症状天数（主要结局）无显著统计学差异。干预组的受试者报告，应用峰流速仪监测哮喘及应用哮喘处方药物，均显著高于常规护理组。其他结局指标，包括生活质量，自我效能感，哮喘知识，或肺功能在组间没有差异。
结论：尽管在对受试者进行干预时有一些行为改变的证据，但这些改变不足以克服症状重的农村贫困人口的高发病率。未来的干预措施应该采用多方面设计，兼顾到监护人的参与，地理位置的问题以及农村地区哮喘患者的接触不足等。
（复旦大学附属中山医院 呼吸内科 罗锦龙 摘译 杨冬 审校）
（Ann Allergy Asthma Immunol, 2018 Feb 19）
（Ann Allergy Asthma Immunol, 2018 Feb 19）
Results of an asthma education program delivered via telemedicine in rural schools.
Tamara T. Perry，et al.
Abstract
BACKGROUND：Asthma morbidity is high among low-income children living in rural U.S. regions, yet few interventions have been designed to reduce asthma burden among rural populations.
OBJECTIVE：Examine the impact of a school-based asthma education program delivered via telemedicine among children living in an impoverished, rural region.
METHODS：We conducted a cluster randomized trial with rural children, ages 7-14 years, comparing a school-based telemedicine asthma education intervention to usual care. The intervention provided comprehensive asthma education via telemedicine to participants and provided evidence-based treatment recommendations to primary care providers.
RESULTS：Of the 393 enrolled children, median age was 9.6 years, 81% were African-American and 47% lived in households with <$14,999 annual income. At enrollment, 88% of children reported uncontrolled asthma symptoms. At the end of the intervention, there were no statistically significant differences in reported symptom free days (primary outcome) for either the intervention or usual care group. Participants in the
intervention group reported significantly higher utilization of peak flow meters to monitor asthma and reported taking their asthma medications as prescribed more frequently when compared to the usual care group. There were no changes in other outcome measures including quality of life, self-efficacy, asthma knowledge, or lung function between groups.
CONCLUSION：Although there was some evidence of behavior change among intervention participants, these changes were inadequate to overcome the significant morbidity experienced by this highly symptomatic rural, impoverished population. Future interventions should be designed with a multifaceted approach that considers caregiver engagement, distance barriers and inadequate access to asthma providers in rural regions.
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哮喘药物治疗依从性的障碍:风俗及环境的重要性
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哮喘诊断工具未来研究的前景：全欧洲哮喘研究创新协作组共识 (EARIP)
