Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich.
Department of Public Health Sciences, Henry Ford Health System, Detroit, Mich.
J Allergy Clin Immunol Pract. 2016 Nov-Dec;4(6):1135-1142. doi: 10.1016/j.jaip.2016.04.024. Epub 2016 Jun 8.
Asthma is a condition that has consistently demonstrated significant health outcome inequalities for minority populations. One approach used for care of patients with asthma is the incorporation of technology for behavioral modification, symptom monitoring, education, and/or treatment decision making. Whether such technological interventions can improve the care of black and inner-city patients is unknown. We reviewed all randomized controlled trial technological interventions from 2000 to 2015 performed in minority populations. A total of 16 articles met inclusion and exclusion criteria; all but 1 was performed in a childhood or adolescent age group. The interventions used MPEG audio layer-3 players, text messaging, computer/Web-based systems, video games, and interactive voice response. Many used tailored content and/or a specific behavior theory. Although the interventions were based on technology, most required additional special staffing. Subject user satisfaction was positive, and improvements were noted in asthma knowledge, medication adherence, asthma symptoms, and quality of life. Unfortunately, health care utilization (emergency department visits and/or hospitalizations) was typically not improved by the interventions. Although no single intervention modality was vastly superior, the computer-based interventions appeared to have the most positive results. In summary, technology-based interventions have a high level of user satisfaction among minority and urban/low-income individuals with asthma, and can improve asthma outcomes. Further large-scale studies are needed to assess whether such interventions can decrease health disparities in asthma.
哮喘是一种对少数族裔人群健康结果存在显著不平等的疾病。用于哮喘患者护理的一种方法是采用技术进行行为改变、症状监测、教育和/或治疗决策。尚不清楚这种技术干预是否可以改善黑人及城市内城区患者的护理。我们对 2000 年至 2015 年间在少数族裔人群中进行的所有随机对照试验技术干预进行了综述。共有 16 篇文章符合纳入和排除标准；除 1 篇以外，其余均在儿童或青少年年龄段进行。干预措施使用了 MPEG 音频层 3 播放器、短信、基于计算机/网络的系统、视频游戏和交互式语音应答。许多措施采用了定制内容和/或特定行为理论。尽管这些干预措施基于技术，但大多数都需要额外的特殊人员配备。患者对用户满意度的评价是积极的，并且在哮喘知识、药物依从性、哮喘症状和生活质量方面都有改善。不幸的是，干预措施通常不会改善医疗保健的利用（急诊就诊和/或住院）。虽然没有单一的干预模式明显占优，但基于计算机的干预措施似乎效果最为积极。总之，基于技术的干预措施在患有哮喘的少数族裔和城市/低收入人群中具有较高的用户满意度，并且可以改善哮喘结果。需要进一步开展大规模研究，以评估此类干预措施是否可以减少哮喘方面的健康差异。
