Horn Ivor B, Mitchell Stephanie J, Gillespie Catherine W, Burke Kristin M, Godoy Leandra, Teach Stephen J
Center for Translational Science, Children's National Medical Center , Washington, DC , USA.
J Asthma. 2014 Nov;51(9):989-95. doi: 10.3109/02770903.2014.930881. Epub 2014 Jun 20.
To determine if a health communication intervention targeting parents of high-risk, urban, minority children with asthma could (i) improve parental perceptions of connectedness to and communication with their child's primary care providers (PCP) and (ii) decrease reliance on emergency departments (EDs) and other urgent care services for their child's asthma-related care.
The design was a single blind, parallel groups, randomized controlled trial. Parents were recruited from an ED-based asthma clinic serving primarily low-income, minority children in Washington, DC. The intervention involved face-to-face education on effective communication followed by a single booster call. Standardized instruments were administered to assess primary care connectedness and healthcare utilization at baseline and 2- and 6-months post-enrollment.
A total of 150 parents of children 1-12 years old were randomized (77 intervention and 73 usual care), and 137 (91%) were successfully followed for six months. Only at the two-month follow-up time-point, parents in the intervention group were significantly more likely to identify a PCP as the main source of their child's asthma care (adjusted odds ratio: 12.6, 95% confidence interval: 1.1-142.1) and to report a significant reduction in ED visits for asthma care (adjusted incidence rate ratio: 0.3, 95% confidence interval: 0.1-0.8). There was no significant effect on parent communication self-efficacy or number of PCP visits.
A brief, in-person health communication intervention for parents of high-risk children with asthma resulted in improved identification of PCPs as the usual source of asthma care and reduced reliance on EDs for asthma care, albeit only for two months post-intervention.
确定一项针对城市高危少数民族哮喘儿童家长的健康沟通干预措施是否能够（i）改善家长对与孩子初级保健提供者（PCP）联系及沟通的认知，以及（ii）减少其孩子哮喘相关护理对急诊科（ED）和其他紧急护理服务的依赖。
采用单盲、平行组随机对照试验设计。从华盛顿特区一家主要为低收入少数民族儿童服务的基于急诊科的哮喘诊所招募家长。干预措施包括面对面的有效沟通教育，随后进行一次强化电话随访。在基线以及入组后2个月和6个月时，使用标准化工具评估初级保健联系情况和医疗保健利用情况。
共150名1至12岁儿童的家长被随机分组（77名接受干预，73名接受常规护理），137名（91%）成功随访6个月。仅在2个月的随访时间点，干预组的家长更有可能将PCP确定为孩子哮喘护理的主要来源（调整后的优势比：12.6，95%置信区间：1.1 - 142.1），并报告因哮喘护理而前往急诊科就诊的次数显著减少（调整后的发病率比：0.3，95%置信区间：0.1 - 0.8）。对家长沟通自我效能或PCP就诊次数没有显著影响。
对高危哮喘儿童家长进行简短的面对面健康沟通干预，可改善将PCP作为哮喘护理常规来源的认知，并减少对急诊科哮喘护理的依赖，尽管仅在干预后两个月内有效。
