Background

The Asthma Action at Erie Trial is a comparative effectiveness trial comparing a community health worker (CHW) versus certified asthma educator (AE-C) intervention in low-income minority children.

Objectives

Determine whether asthma medication possession, adherence, technique, and triggers differ in children receiving an asthma CHW compared with an AE-C intervention.

Methods

Children with uncontrolled asthma were randomized to receive 10 CHW home visits or 2 AE-C sessions in a clinic over 1 year. Asthma medication possession and inhaler technique were observed; adherence was measured using self-report, dose counters, and electronic monitors. Environmental triggers were captured by self-report, observation, and objective measurement. Mixed effects linear and logistic regression models were estimated for continuous and binary outcomes.

Results

Children (n = 223) were mainly Hispanic (85%) and ages 5 to 16 years. Quick-relievers (82%), spacers (72%), and inhaled corticosteroid (ICS)–containing medications (44%) were tracked. Of those with uncontrolled asthma, 35% lacked an ICS prescription (n = 201). Children in the CHW arm were more likely to have an ICS prescription at 12 months (odds ratio 2.39; 95% CI 0.99–5.79). Inhaler technique improved 9.8% in the CHW arm at 6 months (95% CI 4.20–15.32). The ICS adherence improved in the CHW arm at 12 months, with a 16.0% (95% CI 2.3–29.7; P = .02) difference between arms. Differences in trigger exposure over time were not observed between arms.

Conclusions

The CHW services were associated with improved ICS adherence and inhaler technique, compared with AE-C services. More information is needed to determine the necessary dosage of intervention to sustain adherence.

中文翻译：

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提高患有哮喘的城市青年的依从性：社区卫生工作者的作用

 背景

伊利哮喘行动试验是一项比较有效性试验，比较社区卫生工作者 (CHW) 与经过认证的哮喘教育者 (AE-C) 对低收入少数族裔儿童的干预。

 目标

确定接受哮喘 CHW 与 AE-C 干预的儿童的哮喘药物持有、依从性、技术和触发因素是否不同。

 方法

患有不受控制的哮喘的儿童被随机接受 10 次 CHW 家访或 1 年内在诊所接受 2 次 AE-C 疗程。观察哮喘药物持有情况和吸入器技术；使用自我报告、剂量计数器和电子监视器来测量依从性。通过自我报告、观察和客观测量来捕获环境触发因素。混合效应线性和逻辑回归模型被估计为连续和二元结果。

 结果

儿童 (n = 223) 主要是西班牙裔 (85%)，年龄在 5 至 16 岁之间。追踪了快速缓解剂（82%）、间隔器（72%）和含有吸入性皮质类固醇（ICS）的药物（44%）。在哮喘未受控制的患者中，35% 的人没有 ICS 处方 (n = 201)。 CHW 组的儿童更有可能在 12 个月时服用 ICS 处方（比值比 2.39；95% CI 0.99–5.79）。 6 个月时，CHW 组的吸入技术改善了 9.8%（95% CI 4.20-15.32）。 12 个月时，CHW 组的 ICS 依从性有所改善，各组之间的差异为 16.0% (95% CI 2.3–29.7； P = .02)。两组之间没有观察到触发暴露随时间变化的差异。

 结论

与 AE-C 服务相比，CHW 服务与 ICS 依从性和吸入器技术的改善相关。需要更多信息来确定维持依从性所需的干预剂量。