e - health与电话护士病例管理相结合对小儿哮喘控制的影响:随机对照试验%A Gustafson,David %A Wise,Meg %A Bhattacharya,Abhik %A粉粉，Alice %A Shanovich,Kathleen %A Phillips,Brenda %A Lehman,Erik %A Chinchilli,Vernon %A Hawkins,Robert %A Kim, ji - seon +健康增强系统研究中心，威斯康辛大学麦迪逊分校，1513大学大道，4109室，美国WI, 53706, 1 608 263 4882，dhgustaf@wisc.edu %K哮喘%K哮喘信息%K儿童疾病%K病例管理%K患者教育%K电子健康%K社会支持%D 2012 %7 26.07.2012 %9原始论文%J J医学互联网Res %G英文%X背景:哮喘是美国最常见的儿科疾病，低收入和少数族裔家庭负担过重，导致医疗费用高昂。基于临床的哮喘教育和电话病例管理在哮喘控制方面效果好坏参半，电子健康项目和在线游戏也是如此。目的:测试(1)CHESS+CM(一种针对4-12岁哮喘控制不佳的父母和儿童的系统)对哮喘控制和药物依从性的影响，以及(2)作为介质的能力、自我效能和社会支持。CHESS+CM包括一个完全自动化的电子健康组件(综合健康增强支持系统[CHESS])，以及通过电话进行每月护士病例管理(CM)。国际象棋以自我决定理论为基础，旨在提高父母和孩子的能力、社会支持和内在动机。方法:我们从美国威斯康辛州麦迪逊市和密尔沃基市管理医疗机构的档案中找出符合条件的亲子组合，向他们发送招聘信，并随机将他们分配到对照组(无盲)，对照组为常规治疗加哮喘信息组或CHESS+CM组。哮喘控制通过哮喘控制问卷(ACQ)和自我报告无症状天数来衡量。药物依从性是药房补充数据和药物服用的综合。 Social support, information competence, and self-efficacy were self-assessed in questionnaires. All data were collected at 0, 3, 6, 9, and 12 months. Asthma diaries kept during a 3-week run-in period before randomization provided baseline data. Results: Of 305 parent–child dyads enrolled, 301 were randomly assigned, 153 to the control group and 148 to CHESS+CM. Most parents were female (283/301, 94%), African American (150/301, 49.8%), and had a low income as indicated by child’s Medicaid status (154/301, 51.2%); 146 (48.5%) were single and 96 of 301 (31.9%) had a high school education or less. Completion rates were 127 of 153 control group dyads (83.0%) and 132 of 148 CHESS+CM group dyads (89.2%). CHESS+CM group children had significantly better asthma control on the ACQ (d = –0.31, 95% confidence limits [CL] –0.56, –0.06, P = .011), but not as measured by symptom-free days (d = 0.18, 95% CL –0.88, 1.60, P = 1.00). The composite adherence scores did not differ significantly between groups (d = 1.48%, 95% CL –8.15, 11.11, P = .76). Social support was a significant mediator for CHESS+CM’s effect on asthma control (alpha = .200, P = .01; beta = .210, P = .03). Self-efficacy was not significant (alpha = .080, P = .14; beta = .476, P = .01); neither was information competence (alpha = .079, P = .09; beta = .063, P = .64). Conclusions: Integrating telephone case management with eHealth benefited pediatric asthma control, though not medication adherence. Improved methods of measuring medication adherence are needed. Social support appears to be more effective than information in improving pediatric asthma control. Trial Registration: Clinicaltrials.gov NCT00214383; http://clinicaltrials.gov/ct2/show/NCT00214383 (Archived by WebCite at http://www.webcitation.org/68OVwqMPz) %M 22835804 %R 10.2196/jmir.1964 %U //www.mybigtv.com/2012/4/e101/ %U https://doi.org/10.2196/jmir.1964 %U http://www.ncbi.nlm.nih.gov/pubmed/22835804

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