Although asthma affects 6-10% of children aged 6-16 years, the prevalence of asthma in Hispanic groups and the degree of resulting morbidity are unknown. The purpose of this study is to design, implement, and evaluate an intervention program for Hispanic children with asthma which includes both a physician education and a patient/family education component. This study seeks to answer the following questions: 1) Will a physician education intervention result in improved medical management for Hispanic children with asthma who are cared for within the context of an outpatient clinic? 2) Will a focused educational intervention for Hispanic children with asthma and their families result in decreased morbidity and improved quality of life? Prior to enrollment of patients, all physicians will participate in an intervention which includes the following elements: a brief seminar about medical management for children with asthma, introduction of protocols in low chart format (algorithms), use of a standardized progress note from for children with asthma, a series of computer-based simulations and individualized feedback to physicians. The effectiveness of the physician education component in changing physician behavior will be measured by pre- /post-test, chart audit, and performance on computer-based simulations. One hundred sixty (160) Hispanic children with asthma, aged 6-15 years who are cared for in a pediatric residents' continuity clinic will be enrolled for study. A research associate will interview parents and children separately using standardized questionnaires to obtain information about 1) health beliefs, 2) reported health behavior, 3) knowledge and attitudes about asthma, 4) functional morbidity, 5) acculturation, and 6) sociodemographic factors. A research nurse will perform spirometry on each subject. Additional information will be obtained by review of medical records and school attendance records. Patients will then be randomized into treatment and control groups. Treatment group patients and their families will participate in the patient education intervention. The intervention will consist of a series of four videotapes and written materials which focus on major aspects of self-management for children with asthma. Patients and families will receive the four modules at one month intervals. Selected modules will be reviewed with the research nurse at appointed visits approximately 6, 9, and 12 months following enrollment. Follow-up data will be obtained by interview, medical record review, and spirometry at 6, 12, 18, and 24 months following enrollment. Intervention and control group children will be compared for morbidity (# ER visits, # hospitalizations, # school days missed) and quality of life (impact on family and functional status), after controlling for confounding variables. Secondary data analysis will examine the effect of the intervention on knowledge, reported health behaviors, and post-intervention spirometry. If effective, the physician education and patient education programs will serve as models for the implementation of similar programs in outpatient clinic settings which serve Hispanic children with asthma.
| Wood, P R; Hidalgo, H A; Prihoda, T J et al. (1993) Hispanic children with asthma: morbidity. Pediatrics 91:62-9 |
