Griffiths Chris, Bremner Stephen, Islam Kamrul, Sohanpal Ratna, Vidal Debi-Lee, Dawson Carolyn, Foster Gillian, Ramsay Jean, Feder Gene, Taylor Stephanie, Barnes Neil, Choudhury Aklak, Packe Geoff, Bayliss Elizabeth, Trathen Duncan, Moss Philip, Cook Viv, Livingstone Anna Eleri, Eldridge Sandra
Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, United Kingdom.
PLoS One. 2016 Dec 28;11(12):e0158783. doi: 10.1371/journal.pone.0158783. eCollection 2016.
People with asthma from ethnic minority groups experience significant morbidity. Culturally-specific interventions to reduce asthma morbidity are rare. We tested the hypothesis that a culturally-specific education programme, adapted from promising theory-based interventions developed in the USA, would reduce unscheduled care for South Asians with asthma in the UK.
A cluster randomised controlled trial, set in two east London boroughs. 105 of 107 eligible general practices were randomised to usual care or the education programme. Participants were south Asians with asthma aged 3 years and older with recent unscheduled care. The programme had two components: the Physician Asthma Care Education (PACE) programme and the Chronic Disease Self Management Programme (CDSMP), targeted at clinicians and patients with asthma respectively. Both were culturally adapted for south Asians with asthma. Specialist nurses, and primary care teams from intervention practices were trained using the PACE programme. South Asian participants attended an outpatient appointment; those registered with intervention practices received self-management training from PACE-trained specialist nurses, a follow-up appointment with PACE-trained primary care practices, and an invitation to attend the CDSMP. Patients from control practices received usual care. Primary outcome was unscheduled care.
375 south Asians with asthma from 84 general practices took part, 183 registered with intervention practices and 192 with control practices. Primary outcome data were available for 358/375 (95.5%) of participants. The intervention had no effect on time to first unscheduled attendance for asthma (Adjusted Hazard Ratio AHR = 1.19 95% CI 0.92 to 1.53). Time to first review in primary care was reduced (AHR = 2.22, (1.67 to 2.95). Asthma-related quality of life and self-efficacy were improved at 3 months (adjusted mean difference -2.56, (-3.89 to -1.24); 0.44, (0.05 to 0.82) respectively.
A multi-component education programme adapted for south Asians with asthma did not reduce unscheduled care but did improve follow-up in primary care, self-efficacy and quality of life. More effective interventions are needed for south Asians with asthma.
少数族裔哮喘患者的发病率很高。针对特定文化的降低哮喘发病率的干预措施很少见。我们检验了这样一个假设，即根据美国基于理论的有前景的干预措施改编的特定文化教育项目，将减少英国南亚裔哮喘患者的非计划医疗护理。
在伦敦东部的两个行政区进行了一项整群随机对照试验。107家符合条件的全科诊所中的105家被随机分配到常规护理组或教育项目组。参与者为3岁及以上且近期有过非计划医疗护理的南亚裔哮喘患者。该项目有两个组成部分：分别针对临床医生和哮喘患者的医师哮喘护理教育（PACE）项目和慢性病自我管理项目（CDSMP）。这两个项目都针对南亚裔哮喘患者进行了文化适应性调整。干预诊所的专科护士和初级保健团队接受了PACE项目的培训。南亚裔参与者参加了一次门诊预约；在干预诊所注册的患者接受了由PACE培训的专科护士提供的自我管理培训、与PACE培训的初级保健诊所的随访预约，以及参加CDSMP的邀请。对照诊所的患者接受常规护理。主要结局是非计划医疗护理。
来自84家全科诊所的375名南亚裔哮喘患者参与了研究，其中183名在干预诊所注册，192名在对照诊所注册。358/375（95.5%）的参与者有主要结局数据。该干预措施对首次因哮喘进行非计划就诊的时间没有影响（调整后风险比AHR = 1.19，95%置信区间0.92至1.53）。初级保健中首次复诊的时间缩短了（AHR = 2.22，（1.67至2.95））。3个月时，哮喘相关生活质量和自我效能得到改善（调整后平均差分别为 -2.56，（-3.89至 -1.24）；0.44，（0.05至0.82））。
针对南亚裔哮喘患者改编的多成分教育项目并没有减少非计划医疗护理，但确实改善了初级保健中的随访、自我效能和生活质量。对于南亚裔哮喘患者，需要更有效的干预措施。
