关于农村学校哮喘远程医疗教育项目的调查结果
2018/03/05
摘要
背景：在美国农村地区，低收入儿童哮喘发病率很高，但很少有干预措施能够减少农村人口的哮喘负担。
目的：调查生活在贫穷的农村地区的儿童基于学校的通过远程教育方式提供的的哮喘教育方案的影响。
方法: 我们进行了一项针对农村年龄在7-14岁孩子的随机试验，比较学校远程医疗哮喘教育干预与常规护理的区别。干预措施为通过远程医疗向受试者提供全面的哮喘教育，并向初级保健提供者提供循证治疗建议。
结果: 在393名入学儿童中，年龄中位数为9.6岁，81%为非裔美国人，47%人生活在收入14999美元的家庭中。在入学时，88%的儿童报告哮喘症状不受控制。在干预结束时，干预组或常规护理组的无症状天数（主要结局）差异无统计学意义。干预组的参与者报告说，利用峰值流速仪监测哮喘的比例显著提高，并且报告说，与通常的护理组相比，他们更频繁地服用哮喘药物。其他结果指标无变化，包括生活质量、自我效能、哮喘知识或肺功能。
结论：虽然有一些证据表明干预措施使患者存在行为改变，但这些变化不足以克服有哮喘症状的农村贫困人口的重大发病率。未来的干预措施应该设计成一个多方面的方法，考虑到照料者的参与、距离障碍和农村地区获得哮喘诊断的机会不足。
Results of an asthma education program delivered via telemedicine in rural schools.
Perry TT, Halterman JS, Brown RH, Luo C, Randle SM, Hunter CR, Rettiganti M.
Abstract
BACKGROUND: Asthma morbidity is high among low-income children living in rural U.S. regions, yet few interventions have been designed to reduce asthma burden among rural populations.
OBJECTIVE: Examine the impact of a school-based asthma education program delivered via telemedicine among children living in an impoverished, rural region.
METHODS: We conducted a cluster randomized trial with rural children, ages 7-14 years, comparing a school-based telemedicine asthma education intervention to usual care. The intervention provided comprehensive asthma education via telemedicine to participants and provided evidence-based treatment recommendations to primary care providers.
RESULTS: Of the 393 enrolled children, median age was 9.6 years, 81% were African-American and 47% lived in households with <$14,999 annual income. At enrollment, 88% of children reported uncontrolled asthma symptoms. At the end of the intervention, there were no statistically significant differences in reported symptom free days (primary outcome) for either the intervention or usual care group. Participants in the intervention group reported significantly higher utilization of peak flow meters to monitor asthma and reported taking their asthma medications as prescribed more frequently when compared to the usual care group. There were no changes in other outcome measures including quality of life, self-efficacy, asthma knowledge, or lung function between groups.
CONCLUSION: Although there was some evidence of behavior change among intervention participants, these changes were inadequate to overcome the significant morbidity experienced by this highly symptomatic rural, impoverished population. Future interventions should be designed with a multifaceted approach that considers caregiver engagement, distance barriers and inadequate access to asthma providers in rural regions.
背景：在美国农村地区，低收入儿童哮喘发病率很高，但很少有干预措施能够减少农村人口的哮喘负担。
目的：调查生活在贫穷的农村地区的儿童基于学校的通过远程教育方式提供的的哮喘教育方案的影响。
方法: 我们进行了一项针对农村年龄在7-14岁孩子的随机试验，比较学校远程医疗哮喘教育干预与常规护理的区别。干预措施为通过远程医疗向受试者提供全面的哮喘教育，并向初级保健提供者提供循证治疗建议。
结果: 在393名入学儿童中，年龄中位数为9.6岁，81%为非裔美国人，47%人生活在收入14999美元的家庭中。在入学时，88%的儿童报告哮喘症状不受控制。在干预结束时，干预组或常规护理组的无症状天数（主要结局）差异无统计学意义。干预组的参与者报告说，利用峰值流速仪监测哮喘的比例显著提高，并且报告说，与通常的护理组相比，他们更频繁地服用哮喘药物。其他结果指标无变化，包括生活质量、自我效能、哮喘知识或肺功能。
结论：虽然有一些证据表明干预措施使患者存在行为改变，但这些变化不足以克服有哮喘症状的农村贫困人口的重大发病率。未来的干预措施应该设计成一个多方面的方法，考虑到照料者的参与、距离障碍和农村地区获得哮喘诊断的机会不足。
(中日友好医院医院呼吸与危重症一部 李红雯 摘译 林江涛 审校)
(Ann Allergy Asthma Immunol. 2018 Feb 19. pii: S1081-1206(18)30122-4.)
(Ann Allergy Asthma Immunol. 2018 Feb 19. pii: S1081-1206(18)30122-4.)
Results of an asthma education program delivered via telemedicine in rural schools.
Perry TT, Halterman JS, Brown RH, Luo C, Randle SM, Hunter CR, Rettiganti M.
Abstract
BACKGROUND: Asthma morbidity is high among low-income children living in rural U.S. regions, yet few interventions have been designed to reduce asthma burden among rural populations.
OBJECTIVE: Examine the impact of a school-based asthma education program delivered via telemedicine among children living in an impoverished, rural region.
METHODS: We conducted a cluster randomized trial with rural children, ages 7-14 years, comparing a school-based telemedicine asthma education intervention to usual care. The intervention provided comprehensive asthma education via telemedicine to participants and provided evidence-based treatment recommendations to primary care providers.
RESULTS: Of the 393 enrolled children, median age was 9.6 years, 81% were African-American and 47% lived in households with <$14,999 annual income. At enrollment, 88% of children reported uncontrolled asthma symptoms. At the end of the intervention, there were no statistically significant differences in reported symptom free days (primary outcome) for either the intervention or usual care group. Participants in the intervention group reported significantly higher utilization of peak flow meters to monitor asthma and reported taking their asthma medications as prescribed more frequently when compared to the usual care group. There were no changes in other outcome measures including quality of life, self-efficacy, asthma knowledge, or lung function between groups.
CONCLUSION: Although there was some evidence of behavior change among intervention participants, these changes were inadequate to overcome the significant morbidity experienced by this highly symptomatic rural, impoverished population. Future interventions should be designed with a multifaceted approach that considers caregiver engagement, distance barriers and inadequate access to asthma providers in rural regions.
上一篇：
吸入糖皮质激素与成人哮喘控制哮喘：12年随访研究
下一篇：
鼻病毒感染引起的急性哮喘和哮喘增强型流感病毒引起的哮喘的区别
