The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA.
University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA.
J Asthma. 2020 Aug;57(8):820-828. doi: 10.1080/02770903.2019.1619083. Epub 2019 Jun 26.
Asthma evidence-based interventions (EBI) are implemented in the home, school, community or primary care setting. Although families are engaged in one setting, they often have to navigate challenges in another setting. Our objective is to design and implement a comprehensive plan which integrates EBI's and connects the four sectors in underserved communities such as Philadelphia. September 2015-April 2016 we implemented a three-pronged strategy to understand needs and resources of the community including 1) focus groups and key informant interviews, 2) secondary data analysis and 3) pilot testing for implementation to determine gaps in care, and opportunities to overcome those gaps. Analysis of the focus group and key informant responses showed themes: diagnosis fear, clinician time, home and school asthma trigger exposures, school personnel training and communication gaps across all four sectors. EBI's were evaluated and selected to address identified themes. Pilot testing of a community health worker (CHW) intervention to connect home, primary care and school resulted in an efficient transfer of asthma medications and medication administration forms to the school nurse office for students with uncontrolled asthma addressing a common delay leading to poor asthma management in school. Thus far there has been limited success in reducing asthma disparities for low-income minority children. This study offers hope that strategically positioning CHWs may work synergistically to close gaps in care and result in improved asthma control and reduced asthma disparities.
哮喘循证干预措施(EBI)在家庭、学校、社区或初级保健环境中实施。尽管家庭参与了一个环境,但他们往往必须在另一个环境中应对挑战。我们的目标是设计和实施一项综合计划,将 EBI 整合起来,并将四个部门连接起来,服务于费城等服务不足的社区。2015 年 9 月至 2016 年 4 月,我们实施了一项三管齐下的策略,以了解社区的需求和资源,包括 1)焦点小组和关键知情人访谈,2)二次数据分析,3)实施试点,以确定护理差距,并寻找克服这些差距的机会。对焦点小组和关键知情人的回应进行分析显示出以下主题:诊断恐惧、临床医生时间、家庭和学校哮喘触发因素暴露、学校人员培训和所有四个部门之间的沟通差距。对 EBI 进行了评估和选择,以解决已确定的主题。对社区卫生工作者(CHW)干预措施进行试点,以连接家庭、初级保健和学校,将未控制哮喘学生的哮喘药物和用药管理表高效地转交给学校护士办公室,解决了导致学校哮喘管理不善的常见延迟问题。到目前为止,在减少低收入少数民族儿童哮喘差异方面取得的成功有限。这项研究带来了希望,即战略性地定位 CHW 可能会协同工作,弥合护理差距,从而改善哮喘控制并减少哮喘差异。