Xu Cathy, Jackson Mary, Scuffham Paul A, Wootton Richard, Simpson Pamela, Whitty Jennifer, Wolfe Rory, Wainwright Claire E
Centre for Online Health, The University of Queensland, School of Medicine, Brisbane, Queensland 4102, Australia.
J Asthma. 2010 Sep;47(7):768-73. doi: 10.3109/02770903.2010.493966.
To evaluate the effects of an automated interactive voice response system (IVR) and Specialist Nurse Support to reduce health care utilization and improve health-related quality of life in children with asthma.
A randomized controlled trial in 121 children with doctor-diagnosed asthma and an acute presentation with asthma in the previous 12 months aged between 3 and 16 years. Children were randomized to one of three groups for a 6-month intervention receiving asthma education and management support from a Specialist Nurse by telephone or e-mail (N = 41), from IVR (N = 39), or receiving usual care (control group; N = 41). Outcomes included health care utilization and use of oral steroid rescue. Health-related quality of life (HRQOL) data using the Pediatric Asthma Quality of Life Questionnaire and Pediatric Quality of Life Inventory were collected at baseline and at the end of the study.
There was no statistically significant benefit identified for either the IVR or the Nurse Support interventions for health care utilization, use of oral steroid rescue, or HRQOL compared with controls. Relative to controls, the incremental costs were -A$225.73 (95% confidence interval [CI]: -A$840, A$391) per child for the Nurse Support intervention and -A$451.45 (-A$1075, A$173) per child for IVR. The results were most sensitive to the frequency of admissions to hospital.
This study suggested that both IVR and Nurse Support interventions may be cost-saving from a health system perspective, with IVR providing the greatest benefit and this pilot study provides a strong basis for developing larger trials with longer follow-up.
评估自动交互式语音应答系统（IVR）和专科护士支持对减少哮喘儿童医疗保健利用并改善其健康相关生活质量的效果。
一项随机对照试验，纳入121名经医生诊断为哮喘且在过去12个月内有哮喘急性发作的3至16岁儿童。将儿童随机分为三组之一，进行为期6个月的干预，通过电话或电子邮件接受专科护士的哮喘教育和管理支持（N = 41）、接受IVR支持（N = 39）或接受常规护理（对照组；N = 41）。结局指标包括医疗保健利用情况和口服类固醇急救药物的使用情况。在基线和研究结束时收集使用儿童哮喘生活质量问卷和儿童生活质量量表的健康相关生活质量（HRQOL）数据。
与对照组相比，IVR或护士支持干预在医疗保健利用、口服类固醇急救药物使用或HRQOL方面均未发现有统计学意义的益处。相对于对照组，护士支持干预的增量成本为每名儿童-A$225.73（95%置信区间[CI]：-A$840，A$391），IVR为每名儿童-A$451.45（-A$1075，A$173）。结果对住院频率最为敏感。
本研究表明，从卫生系统角度来看，IVR和护士支持干预均可能节省成本，其中IVR带来的益处最大，且这项试点研究为开展更长随访期的更大规模试验提供了有力依据。
