Chronic Disease and Injury Prevention Section, Public Health-Seattle and King County, Seattle, Washington2School of Public Health, University of Washington, Seattle, Washington3School of Medicine, University of Washington, Seattle, Washington.
Assessment, Policy Development, and Evaluation Unit, Public Health-Seattle and King County, Seattle, Washington.
JAMA Intern Med. 2015 Jan;175(1):109-17. doi: 10.1001/jamainternmed.2014.6353.
Asthma is often poorly controlled. Home visitation by community health workers (CHWs) to improve control among adults has not been adequately evaluated.
To test the hypothesis that CHW home visits for adults with uncontrolled asthma improve outcomes relative to usual care.
DESIGN, SETTING, AND PARTICIPANTS: Randomized parallel group study with 1-year follow-up, conducted 2008 through 2011 at homes of low-income adults aged 18 to 65 years with uncontrolled asthma living in King County, Washington.
The CHWs provided a mean of 4.9 home visits during a 1-year period to assess asthma control, self-management, and home environment and to support asthma self-management practices.
Primary prespecified outcomes were symptom-free days (number of 24-hour periods in prior 2 weeks without asthma symptoms), asthma-related quality of life (Mini Asthma Quality of Life Questionnaire), and asthma-related unscheduled health care use.
Of 463 individuals who completed eligibility screening, 443 were eligible, 366 participated (177 in intervention and 189 in control groups), and 333 completed the study (91%). The intervention group had significantly greater increases in mean symptom-free days per 2 weeks (2.02 [95% CI, 0.94-3.09]; P < .001) and quality of life (0.50 [95% CI, 0.28-0.71] points; P < .001) relative to the control group, adjusted for age, sex, race/ethnicity, and education level. The number needed to treat to increase symptom-free days by 2 days per 2 weeks was 7.4 and to improve quality of life by 0.5 points was 2.6. Mean urgent health care use episodes in the past 12 months decreased significantly and similarly in both groups, from a mean of 3.46 to 1.99 episodes in the intervention group (mean change, -1.47 [95% CI, -2.28 to -0.67]; P < .001) and from a mean of 3.30 to 1.96 episodes in the control group (mean change, -1.34 [95% CI, -2.00 to -0.72]; P < .001) (P = .83 comparing groups).
The provision of in-home asthma self-management support by CHWs to low-income adults with uncontrolled asthma improves asthma control and quality of life but not unscheduled health care use. Additional studies are needed to confirm these findings and determine the value of wider implementation of this approach.
clinicaltrials.gov Identifier: NCT01783028.
哮喘常常控制不佳。社区卫生工作者（CHW）上门为成年人改善控制，这种方法尚未得到充分评估。
检验 CHW 上门为控制不佳的成年哮喘患者提供服务是否可改善结局，优于常规护理。
设计、地点和参与者：这是一项随机平行分组研究，于 2008 年至 2011 年在华盛顿州金县低收入、年龄在 18 至 65 岁间、有未控制哮喘且居住在家中的成年人中进行，参与者为在家中接受评估哮喘控制、自我管理、家庭环境情况和支持哮喘自我管理的社区卫生工作者（CHW）。
CHW 在 1 年期间平均进行 4.9 次家访，以评估哮喘控制情况、自我管理情况和家庭环境，并支持哮喘自我管理。
主要预设结局为无症状天数（前 2 周内无哮喘症状的 24 小时周期数）、哮喘相关生活质量（哮喘生活质量调查问卷）和哮喘相关非计划性卫生保健使用。
在完成资格筛选的 463 名患者中，443 名患者符合条件，366 名患者参与（干预组 177 名，对照组 189 名），333 名患者完成研究（91%）。与对照组相比，干预组患者的平均无症状天数/2 周（2.02 [95%CI，0.94-3.09]；P <.001）和生活质量（0.50 [95%CI，0.28-0.71] 分；P <.001）有显著增加，调整了年龄、性别、种族和教育水平。为增加无症状天数 2 天/2 周，需要治疗的人数（NNT）为 7.4，为提高生活质量 0.5 分，NNT 为 2.6。两组患者在过去 12 个月内紧急卫生保健使用次数均显著且相似地减少，干预组从平均 3.46 次降至 1.99 次（平均变化，-1.47 [95%CI，-2.28 至 -0.67]；P <.001），对照组从平均 3.30 次降至 1.96 次（平均变化，-1.34 [95%CI，-2.00 至 -0.72]；P <.001）（组间比较，P =.83）。
为低收入、未控制哮喘的成年人提供家庭哮喘自我管理支持的社区卫生工作者可改善哮喘控制和生活质量，但不会减少非计划性卫生保健使用。还需要开展更多研究以证实这些发现，并确定广泛采用这种方法的价值。
clinicaltrials.gov 标识符：NCT01783028。
