First, this study will extend and expand our initial investigation into the impact of an asthma education program for inner city minority patients and their health care providers at four neighborhood centers. We will continue to monitor the course of 100 patients with asthma entered into a random it has not controlled clinical trial of education in asthma co-management skills. We will further characterize the atopic status of these individuals by blood allergy and allergy skin testing, correlated with dust sampling from environments, from a randomly selected sample. After the final year of follow-up of patients randomized in the first the first grant cycle, patients randomized to groups 1 and 2 will be offered the group 3 education program """"""""step-up"""""""" phase). Outcome measures to assess differences among groups include frequency of attacks, asthma knowledge and asthma management self-confidence, behavioral compliance, and global functional status. Second, this program will assess the impact of a series of health care provider educational sessions regarding asthma management on the providers' behaviors and on the clinical outcomes of their patients. Approximately 32 doctors and nurses at the health centers are the primary care providers inner-city, predominantly minority asthmatic patients. Medical chart review data obtained during the processes outreach phase (1995-1999) will be compared with data obtained prior to initiation of the initial intervention (1990-1992) and with data from the current phase of the study (1992-1995). Our principal goals are increased prescription of inhaled anti-inflammatory therapies, increased utilization of lung function measurements, and increased patient education. Third, we will develop and evaluate novel programs aimed at recruiting into the asthma education study the hard-to-reach, previously non-participating asthmatic patients at the health centers. We have found the majority of asthmatic patients in this impoverished inner-city community to be unreachable by mail or telephone, non-compliant with scheduled meetings, or disinterested in learning asthma co-management skills. Targeting this group, we will use techniques derived from diffusion theory and social marketing theory to attract at least 100 additional individuals into our education program. We anticipate introduction of a health care provider """"""""asthma education prescription,"""""""" use of community opinion leaders who have asthma as """"""""asthma education advocates"""""""", and promotion through public media services of a community- wide asthma awareness program will encourage participation; we will actively seek consultation with it social agencies to develop culturally sensitive and effective approaches toward patient recruitment.
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