Otsuki Michiko, Eakin Michelle N, Rand Cynthia S, Butz Arlene M, Hsu Van Doren, Zuckerman Ilene H, Ogborn Jean, Bilderback Andrew, Riekert Kristin A
Department of Psychology, University of South Florida St Petersburg, St Petersburg, Florida, USA.
Pediatrics. 2009 Dec;124(6):1513-21. doi: 10.1542/peds.2008-2961.
We evaluated the longitudinal effects of home-based asthma education combined with medication adherence feedback (adherence monitoring with feedback [AMF]) and asthma education alone (asthma basic care [ABC]) on asthma outcomes, relative to a usual-care (UC) control group.
A total of 250 inner-city children with asthma (mean age: 7 years; 62% male; 98% black) were recruited from a pediatric emergency department (ED). Health-outcome measures included caregiver-frequency of asthma symptoms, ED visits, hospitalizations, and courses of oral corticosteroids at baseline and 6-, 12-, and 18-month assessments. Adherence measures included caregiver-reported adherence to inhaled corticosteroid (ICS) therapy and pharmacy records of ICS refills. Multilevel modeling was used to examine the differential effects of AMF and ABC compared with UC.
ED visits decreased more rapidly for the AMF group than for the UC group, but no difference was found between the ABC and UC groups. The AMF intervention led to short-term improvements in ICS adherence during the active-intervention phase relative to UC, but this improvement decreased over time. Asthma symptoms and courses of corticosteroids decreased more rapidly for the ABC group than for the UC group. Hospitalization rates did not differ between either intervention group and the UC group. No differences were found between the ABC and AMF groups on any outcome.
Asthma education led to improved adherence and decreased morbidity compared with UC. Home-based educational interventions may lead to modest short-term improvements in asthma outcomes among inner-city children. Adherence feedback did not improve outcomes over education alone.
我们评估了相对于常规护理（UC）对照组，家庭哮喘教育联合药物依从性反馈（带反馈的依从性监测[AMF]）及单纯哮喘教育（哮喘基本护理[ABC]）对哮喘结局的纵向影响。
从一家儿科急诊科招募了总共250名患有哮喘的市中心儿童（平均年龄：7岁；62%为男性；98%为黑人）。健康结局指标包括在基线以及6个月、12个月和18个月评估时照顾者报告的哮喘症状出现频率、急诊科就诊次数、住院次数以及口服糖皮质激素疗程。依从性指标包括照顾者报告的吸入性糖皮质激素（ICS）治疗依从性以及ICS再填充的药房记录。采用多水平模型来检验AMF和ABC相对于UC的差异效应。
AMF组的急诊科就诊次数比UC组下降得更快，但ABC组和UC组之间未发现差异。相对于UC，AMF干预在积极干预阶段导致ICS依从性有短期改善，但这种改善随时间推移而下降。ABC组的哮喘症状和糖皮质激素疗程比UC组下降得更快。两个干预组与UC组之间的住院率没有差异。ABC组和AMF组在任何结局指标上均未发现差异。
与UC相比，哮喘教育导致依从性提高且发病率降低。家庭式教育干预可能会使市中心儿童的哮喘结局在短期内有适度改善。依从性反馈并未比单纯教育更能改善结局。
