Social Support and Education in Asthma Follow-up (SSEA)
| Status: | Completed |
|---|---|
| Conditions: | Asthma |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 2 - 10 |
| Updated: | 5/10/2018 |
| Start Date: | September 2003 |
| End Date: | May 2008 |
We will evaluate the effect of an eighteen-month asthma coaching intervention for
parents/caregivers of children with asthma to reduce asthma morbidity. The primary objective
is to determine if asthma coaching will significantly reduce asthma morbidity as measured by
a reduction in the number of ED visits and hospitalizations for the children during the 18
months of active coaching and during the 18 months after the coaching stops.
We will provide half of the subjects (parents/caregivers) with access to assistance from an
asthma coach for 18 months (including 2 contacts with an asthma nurse during the first 6
months). The other half of the subjects will not have an asthma coach, but their children
will have their usual routine care with their primary care providers. The nurse and coach
will help the subjects learn more about caring for their children's asthma and improving
interactions with the primary care providers for their children.
parents/caregivers of children with asthma to reduce asthma morbidity. The primary objective
is to determine if asthma coaching will significantly reduce asthma morbidity as measured by
a reduction in the number of ED visits and hospitalizations for the children during the 18
months of active coaching and during the 18 months after the coaching stops.
We will provide half of the subjects (parents/caregivers) with access to assistance from an
asthma coach for 18 months (including 2 contacts with an asthma nurse during the first 6
months). The other half of the subjects will not have an asthma coach, but their children
will have their usual routine care with their primary care providers. The nurse and coach
will help the subjects learn more about caring for their children's asthma and improving
interactions with the primary care providers for their children.
BACKGROUND:
Our previous NHLBI-supported study (HL 57232) showed that a combination treatment of
"Coaching" through follow-up phone calls 2 and 5 days following an index ED visit plus
monetary incentive was highly effective in increasing the percentage of low-income urban
children who received recommended primary care within 2 weeks of the ED visit for asthma, 44%
in the intervention group vs 29% in usual care (p = 0.0004). However, the intervention was
not associated with significant differences in morbidity (subsequent ED visits). We conclude
that the intervention was effective in promoting the initial link to primary care, but was
not effective in sustaining that link or management practices to minimize acuity of symptoms
during exacerbation.
DESIGN NARRATIVE:
Primary outcome The proportion of children of subjects in each group who have at least one ED
visit for acute asthma symptoms during the thirty-six month period following enrollment.
Key secondary outcomes A. The proportion of children of subjects in each group who are
hospitalized during the thirty-six month period following enrollment.
B. The proportion of children of subjects in each group who have either acute asthma visits
or asthma-planning visits with their primary care providers.
C. The costs of asthma-related care during the thirty-six month period D. Variables which may
mediate or moderate the intervention such as the attitudes toward asthma care of the subjects
and the personal social support perceived by the subjects .
Our previous NHLBI-supported study (HL 57232) showed that a combination treatment of
"Coaching" through follow-up phone calls 2 and 5 days following an index ED visit plus
monetary incentive was highly effective in increasing the percentage of low-income urban
children who received recommended primary care within 2 weeks of the ED visit for asthma, 44%
in the intervention group vs 29% in usual care (p = 0.0004). However, the intervention was
not associated with significant differences in morbidity (subsequent ED visits). We conclude
that the intervention was effective in promoting the initial link to primary care, but was
not effective in sustaining that link or management practices to minimize acuity of symptoms
during exacerbation.
DESIGN NARRATIVE:
Primary outcome The proportion of children of subjects in each group who have at least one ED
visit for acute asthma symptoms during the thirty-six month period following enrollment.
Key secondary outcomes A. The proportion of children of subjects in each group who are
hospitalized during the thirty-six month period following enrollment.
B. The proportion of children of subjects in each group who have either acute asthma visits
or asthma-planning visits with their primary care providers.
C. The costs of asthma-related care during the thirty-six month period D. Variables which may
mediate or moderate the intervention such as the attitudes toward asthma care of the subjects
and the personal social support perceived by the subjects .
Inclusion criteria:
A. The child of the parent/caregiver has a diagnosis of asthma made by a physician and
reported by the parent, or diagnosis of asthma made during the ED visit if the child has
experienced two previous wheezing episodes.
B. The child will undergo treatment during the enrollment ED visit for the current asthma
exacerbation, as determined by the treating ED clinician. As a result, only
parents/caregivers with children experiencing a significant wheezing episode will be
entered into the study.
C. The child is 2-10 years of age (second birth date until, but not including, eleventh
birth date).
D. The child has Medicaid or no medical insurance. This criterion permits easy
identification and selection of low-income children/families, who are the target population
for this proposal.
E. The parent/caregiver has a working telephone at home. F. The child attends one of the
target practices (7 private practices and 5 federally funded clinics) for routine care.
G. The parent/caregiver and child live within the St. Louis metro area.
Exclusion criteria:
A. The child attends a practice other than the target group. B. The parent/caregiver and
child live outside of the St. Louis metro area. C. The child has a chronic illness other
than asthma that manifests as wheezing or respiratory symptoms.
D. The parent/caregiver does not have a working telephone in home. E. The parent/caregiver
is not able to effectively communicate in English.
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