Flores Glenn, Bridon Christina, Torres Sylvia, Perez Ruth, Walter Tim, Brotanek Jane, Lin Hua, Tomany-Korman Sandy
Division of General Pediatrics, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390, USA.
Pediatrics. 2009 Dec;124(6):1522-32. doi: 10.1542/peds.2009-0230.
Because asthma disproportionately affects minorities, we evaluated the effects of parent mentors (PMs) on asthma outcomes in minority children.
This randomized, controlled trial allocated minority asthmatic children to the PM intervention or traditional asthma care. Intervention families were assigned PMs (experienced parents of asthmatic children who received specialized training). PMs met monthly with children and families at community sites, phoned parents monthly, and made home visits. Ten asthma outcomes and costs were monitored for 1 year. Outcomes were examined by using both intention-to-treat analyses and stratified analyses for high participants (attending >or=25% of community meetings and completing >or=50% of PM phone interactions).
Patients were randomly assigned to PMs (n = 112) or the control group (n = 108). In intention-to-treat analyses, intervention but not control children experienced significantly reduced rapid-breathing episodes, asthma exacerbations, and emergency department (ED) visits. High participants (but not controls or low participants) experienced significantly reduced wheezing, asthma exacerbations, and ED visits and improved parental efficacy in knowing when breathing problems are controllable at home. Mean reductions in missed parental work days were greater for high participants than controls. The average monthly cost per patient for the PM program was $60.42, and net savings of $46.16 for high participants.
For asthmatic minority children, PMs can reduce wheezing, asthma exacerbations, ED visits, and missed parental work days while improving parental self-efficacy. These outcomes are achieved at a reasonable cost and with net cost savings for high participants. PMs may be a promising, cost-effective means for reducing childhood asthma disparities.
由于哮喘对少数族裔的影响尤为严重，我们评估了家长导师（PMs）对少数族裔儿童哮喘治疗效果的影响。
这项随机对照试验将少数族裔哮喘儿童分为接受家长导师干预组或传统哮喘护理组。干预组家庭被分配了家长导师（有哮喘患儿的经验丰富家长，他们接受了专门培训）。家长导师每月在社区场所与儿童及其家庭会面，每月给家长打电话，并进行家访。对10项哮喘治疗效果指标和费用进行了为期1年的监测。通过意向性分析和对高参与度参与者（参加≥25%的社区会议且完成≥50%的家长导师电话互动）的分层分析来检验治疗效果。
患者被随机分配到家长导师组（n = 112）或对照组（n = 108）。在意向性分析中，干预组儿童（而非对照组儿童）的呼吸急促发作、哮喘加重和急诊就诊次数显著减少。高参与度参与者（而非对照组或低参与度参与者）的喘息、哮喘加重和急诊就诊次数显著减少，且家长在了解家中呼吸问题何时可控方面的效能有所提高。高参与度参与者错过的家长工作日平均减少量大于对照组。家长导师项目每位患者每月的平均费用为60.42美元，高参与度参与者净节省46.16美元。
对于患有哮喘的少数族裔儿童，家长导师可以减少喘息、哮喘加重、急诊就诊次数和家长错过的工作日，同时提高家长的自我效能。这些治疗效果是以合理成本实现的，且高参与度参与者有净成本节省。家长导师可能是减少儿童哮喘差异的一种有前景、具有成本效益的手段。
