哮喘联盟

   摘要
   目的：贫困地区儿童在哮喘急诊科（ED）就诊后预防性保健随访率低。本研究的目的是检验临床医生和护理人员反馈干预（INT）对哮喘急诊科（ED）就诊后改善中的预防性哮喘护理的有效性，结果与对照组(CON)进行比较。
   方法：研究纳入300例伴持续性哮喘并且近期曾到哮喘急诊科就诊的儿童，随机分为反馈干预组和对照组，随访12个月。所有儿童接受护士随访。数据通过访问、儿童唾液中可替宁的水平和药房的记录获得。通过标准t检验、卡方和多因素逻辑回归测试来检验两组在超过12个月期间，报告>两位初级护理提供者（PCP）进行的预防性哮喘护理随访的组间差异。
   结果：纳入儿童主要为3～5岁男性，有医疗保险的美国黑人。超过12个月的平均ED就诊次数较高（2.29次）。两组在发生两次或两次以上的PCP随访/12个月或有哮喘行动计划（AAP）方面无差异。基线有AAP的儿童在超过12个月期间发生两位或更多PCP的随访几乎是对照的两倍，同时控制了哮喘控制能力、组状态、儿童年龄和哮喘急诊就诊访次数。
   结论：临床医师和护理反馈干预较对照组在提高哮喘预防性护理方面并不成功。有效预防贫困地区高危儿童发病并频繁到急诊就诊的干预措施还有待进一步研究。
 

（苏楠 审校） 
J Asthma. 2014 Feb 12. [Epub ahead of print]


 

Improving Preventive Care in High Risk Children with Asthma: Lessons Learned.
 

Butz AM, Halterman J, Bellin M, Kub J, Tsoukleris M, Frick KD, Thompson RE, Land C, Bollinger ME.
 

Abstract
ABSTRACT OBJECTIVES: Rates of preventive asthma care after an asthma emergency department (ED) visit are low among inner-city children.The objective of this study was to test the efficacy of a clinician and caregiver feedback intervention (INT) on improving preventive asthma care following an asthma ED visit compared to an attention control group (CON).
METHODS: Children with persistent asthma and recent asthma ED visits (N=300) were enrolled and randomized into a feedback intervention or an attention control group and followed for 12 months. All children received nurse visits. Data were obtained from interviews, child salivary cotinine levels and pharmacy records. Standard t-test, chi-square and multiple logistic regression tests were used to test for differences between the groups for reporting > two primary care provider (PCP) preventive care visits for asthma over 12 months.
RESULTS: Children were primarily male, young (3-5 years), African American, and Medicaid insured. Mean ED visits over 12 months was high (2.29 visits). No difference by group was noted for attending two or more PCP visits/12 months or having an asthma action plan (AAP). Children having an AAP at baseline were almost twice as likely to attend two or more PCP visits over 12 months while controlling for asthma control, group status, child age, and number of asthma ED visits.
CONCLUSIONS: A clinician and caregiver feedback intervention was unsuccessful in increasing asthma preventive care compared to an attention control group. Further research is needed to develop interventions to effectively prevent morbidity in high risk inner-city children with frequent ED utilization.
 

J Asthma. 2014 Feb 12. [Epub ahead of print]