Department of Psychology, Virginia Commonwealth University, Richmond, United States.
Department of Biostatistics, Virginia Commonwealth University, Richmond, United States.
J Pediatr Psychol. 2024 Oct 1;49(10):677-688. doi: 10.1093/jpepsy/jsae052.
This study tested a randomized controlled trial of RVA Breathes, a community asthma program, in reducing asthma-related healthcare utilization among children living in an area with a high poverty rate.
Participants included 250 caregivers (78% African American/Black; 73.3% household income<$25,000/year) and their children with asthma (5-11 years). Inclusion criteria included an asthma-related emergency department (ED) visit, hospitalization, unscheduled doctor's visit, or systemic steroids in the past 2 years. Families were randomized to a full active intervention (asthma education with community health workers [CHWs], home remediation with home assessors, and a school nurse component; n = 118), partial active intervention (asthma education and home remediation; n = 69), or a control group (n = 63) for 9 months. Measures on healthcare utilization and asthma-related factors were collected. Follow-up assessments occurred across a 9-month period.
Although we did not find any significant effects, there was a trend toward significance for a group by time effect with objective healthcare utilization as the outcome (F4,365 = 2.28, p = .061). The full intervention group experienced a significant decrease from baseline to 9-month follow-up compared with the other groups (p < .001). Only the full intervention group experienced a significant increase in reported asthma action plans across time (no significant group effect).
In the context of the unprecedented COVID-19 pandemic, which led to a substantial global decrease in healthcare utilization, the study's main hypotheses were not supported. Nevertheless, findings support the benefit of community asthma programs that integrate care across multiple settings and connect families with CHWs.
本研究旨在通过一项针对 RVA Breathes 的随机对照试验，评估该社区哮喘项目对生活在高贫困率地区的儿童哮喘相关医疗保健利用的影响。
研究对象为 250 名（78%为非裔美国人/黑人；73.3%家庭收入<25,000 美元/年）患儿及其照顾者。纳入标准包括过去 2 年内发生过哮喘相关的急诊就诊、住院、非计划就诊或全身使用皮质类固醇。将家庭随机分为全活跃干预组（哮喘教育与社区卫生工作者[CHWs]、家庭改善与家庭评估员、以及学校护士组成；n=118）、部分活跃干预组（哮喘教育和家庭改善；n=69）或对照组（n=63），干预时长为 9 个月。研究收集了医疗保健利用和哮喘相关因素的测量结果。随访评估在 9 个月期间进行。
尽管我们没有发现任何显著效果，但在以客观医疗保健利用为结果的组间时间效应上存在趋势（F4,365=2.28，p=0.061）。与其他组相比，全干预组从基线到 9 个月随访时的客观医疗保健利用率显著下降（p<0.001）。仅全干预组的哮喘行动计划报告在时间上有显著增加（无显著组间效应）。
在前所未有的 COVID-19 大流行背景下，全球医疗保健利用大幅下降，本研究的主要假设未得到支持。然而，研究结果支持了整合多场所护理并将家庭与 CHWs 联系起来的社区哮喘项目的益处。
