Section of Hospital Medicine, Department of Medicine, University of Chicago, 5841 S. Maryland Ave, MC 5000, W305, Chicago, IL 60637, USA.
J Gen Intern Med. 2012 Aug;27(8):1001-15. doi: 10.1007/s11606-012-2058-9.
To systematically review the literature to characterize interventions with potential to improve outcomes for minority patients with asthma.
Medline, PsycINFO, CINAHL, Cochrane Trial Databases, expert review, reference review, meeting abstracts. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTEVENTIONS: Medical Subject Heading (MeSH) terms related to asthma were combined with terms to identify intervention studies focused on minority populations.
adult population; intervention studies with majority of non-White participants. STUDY APPRAISAL AND SYNTHESIS OF METHODS: Study quality was assessed using Downs and Black (DB) checklists. We examined heterogeneity of studies through comparing study population, study design, intervention characteristics, and outcomes.
Twenty-four articles met inclusion criteria. Mean quality score was 21.0. Study populations targeted primarily African American (n = 14), followed by Latino/a (n = 4), Asian Americans (n = 1), or a combination of the above (n = 5). The most commonly reported post-intervention outcome was use of health care resources, followed by symptom control and self-management skills. The most common intervention-type studied was patient education. Although less-than half were culturally tailored, language-appropriate education appeared particularly successful. Several system-level interventions focused on specialty clinics with promising findings, although health disparities collaboratives did not have similarly promising results.
Publication bias may limit our findings; we were unable to perform a meta-analysis limiting the review's quantitative evaluation.
Overall, education delivered by health care professionals appeared effective in improving outcomes for minority patients with asthma. Few were culturally tailored and one included a comparison group, limiting the conclusions that can be drawn from cultural tailoring. System-redesign showed great promise, particularly the use of team-based specialty clinics and long-term follow-up after acute care visits. Future research should evaluate the role of tailoring educational strategies, focus on patient-centered education, and incorporate outpatient follow-up and/or a team-based approach.
系统地回顾文献，以描述有可能改善少数族裔哮喘患者结局的干预措施。
Medline、PsycINFO、CINAHL、Cochrane 试验数据库、专家审查、参考文献审查、会议摘要。
研究入选标准、参与者和干预措施：使用医学主题词（MeSH）与识别以少数族裔人群为重点的干预研究相关的术语。
成人人群；以非白人参与者为主的干预研究。
使用 Downs 和 Black（DB）清单评估研究质量。我们通过比较研究人群、研究设计、干预措施特征和结局来检查研究之间的异质性。
24 篇文章符合纳入标准。平均质量评分为 21.0。研究人群主要针对非裔美国人（n=14），其次是拉丁裔/西班牙裔（n=4）、亚裔美国人（n=1）或上述人群的组合（n=5）。报告的最常见干预后结局是使用医疗保健资源，其次是症状控制和自我管理技能。研究最多的干预类型是患者教育。尽管不到一半的干预措施是文化上量身定制的，但语言适宜的教育似乎特别成功。一些专注于专科诊所的系统级干预措施取得了有希望的结果，尽管卫生差异合作项目没有取得类似的成果。
发表偏倚可能限制我们的研究结果；由于限制了综述的定量评估，我们无法进行荟萃分析。
总体而言，专业医疗保健人员提供的教育似乎可以有效改善少数族裔哮喘患者的结局。很少有针对文化差异进行调整的研究，其中一项研究包括了一个对照组，这限制了从文化调整中得出的结论。系统重新设计显示出巨大的潜力，特别是使用基于团队的专科诊所和急性护理就诊后的长期随访。未来的研究应评估调整教育策略的作用，注重以患者为中心的教育，并纳入门诊随访和/或基于团队的方法。
