Margellos-Anast Helen, Gutierrez Melissa A, Whitman Steven
Sinai Urban Health Institute, Sinai Health System, Chicago, IL 60608, USA.
J Asthma. 2012 May;49(4):380-9. doi: 10.3109/02770903.2012.660295. Epub 2012 Feb 21.
Asthma affects 25-30% of children living in certain disadvantaged Chicago neighborhoods, a rate twice the national prevalence (13%). Children living in poor, minority communities tend to rely heavily on the emergency department (ED) for asthma care and are unlikely to be properly medicated or educated on asthma self-management. A pilot project implemented and evaluated a community health worker (CHW) model for its effectiveness in reducing asthma morbidity and improving the quality of life among African-American children living in disadvantaged Chicago neighborhoods.
Trained CHWs from targeted communities provided individualized asthma education during three to four home visits over 6 months. The CHWs also served as liaisons between families and the medical system. Seventy children were enrolled into the pilot phase between 15 November 2004 and 15 July 2005, of which 96% were insured by Medicaid and 54% lived with a smoker. Prior to starting, the study was approved by an institutional review board. Data on 50 children (71.4%) who completed the entire 12-month evaluation phase were analyzed using a before and after study design.
Findings indicate improved asthma control. Specifically, symptom frequency was reduced by 35% and urgent health resource utilization by 75% between the pre- and post-intervention periods. Parental quality of life also improved by a level that was both clinically and statistically significant. Other important outcomes included improved asthma-related knowledge, decreased exposure to asthma triggers, and improved medical management. The intervention was also shown to be cost-effective, resulting in an estimated $5.58 saved per dollar spent on the intervention.
Findings suggest that individualized asthma education provided by a trained, culturally competent CHW is effective in improving asthma management among poorly controlled, inner-city children. Further studies are needed to affirm the findings and assess the model's generalizability.
哮喘影响着居住在芝加哥某些贫困社区25%至30%的儿童，这一比例是全国患病率（13%）的两倍。生活在贫困少数族裔社区的儿童在哮喘护理方面往往严重依赖急诊科，而且不太可能得到适当的药物治疗或接受哮喘自我管理教育。一个试点项目实施并评估了社区卫生工作者（CHW）模式，以了解其在降低芝加哥贫困社区非裔美国儿童哮喘发病率和改善生活质量方面的有效性。
来自目标社区的经过培训的社区卫生工作者在6个月内进行三到四次家访，提供个性化的哮喘教育。社区卫生工作者还充当家庭与医疗系统之间的联络人。2004年11月15日至2005年7月15日期间，70名儿童进入试点阶段，其中96%参加了医疗补助计划，54%与吸烟者同住。在开始之前，该研究获得了机构审查委员会的批准。使用前后研究设计对完成整个12个月评估阶段的50名儿童（71.4%）的数据进行了分析。
研究结果表明哮喘得到了更好的控制。具体而言，干预前后症状频率降低了35%，紧急医疗资源利用率降低了75%。父母的生活质量也有了临床和统计学上均显著的提高。其他重要成果包括哮喘相关知识的改善、接触哮喘诱因的减少以及医疗管理的改善。该干预措施还被证明具有成本效益，每花费1美元进行干预估计可节省5.58美元。
研究结果表明，由训练有素、具备文化能力的社区卫生工作者提供的个性化哮喘教育，对于改善控制不佳的市中心儿童的哮喘管理是有效的。需要进一步研究来证实这些发现并评估该模式的普遍性。
