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Noreen Clark, PhD Molly Gong, MDJulie Dodge, MSSijian Wang, M.S.Xihong Lin, PhDWilliam Bria, MD Timothy Johnson, MD
University of MichiganSchool of Public HealthSupported by NHLBI grant 1 R18 HL60884
Long Term Effect of A self-Regulation Education on Inhaled Anti-Inflammatory Medicines and Short-Acting Bronchodilator
BACKGROUD
Inhaled anti-inflammatory medicines are suggested for disease control in asthma patients (NAEPP).Increasing use of short-acting bronchodilators indicates inadequate control of the disease (NAEPP).
PURPOSE
To examine and evaluate the effectiveness of a self-regulation telephone counseling intervention for women with asthma on medication use in a randomized clinical trail.
METHODS
Recruitment Women 18 years and older Physician diagnosis Attending University of Michigan
Asthma & Airways Clinic and University of Michigan Health System
Data Collection
Telephone interview
Demographics Asthma symptoms Health care utilization Gender-related management Peak flow meter use
Study Sample
Baseline 808
Follow up I* 608
Follow up II** 580
• One year subsequent to baseline data collection• One year subsequent to follow up I data collection
Demographics: Age
13%
7% 9%
21%
26%
24%
18-30
31-40
41-50
51-60
61-70
>71
Demographics: Education
21%
4%
26%
20%29%
< High School
High School
2-year College
4-year College
Post Grad
Demographics: Income
18%
16%
13%
15%
11%
13%
7%7% <10,000
10,001-20,000
20,001-40,000
40,001-60,000
60,001-80,000
80,000-100,000
>100,000
Not reported
Demographics: Race/Ethnicity
2%1%2%
11%
2%
84%Caucasian/White
African American/Black
Asian/Pacific Islander
Hispanic/Latino
Native American
Other
Intervention
Subsequent to baseline data collection, women were randomly assigned to either the control or the intervention group.
Women in the intervention group received the self-regulation telephone counseling intervention: Women Breathe Free.
Data Analyses
To examine: 1. Relationships between
demographics vs. Medication use at baseline: Frequencies with Odds Ratio
2. Program effects on medication use: Generalized Estimating Equations (GEE) with logit link using entire sample (intent-to-treat)
FINDINGSAsthma Severity
Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, 1997
Percent of Women
Mild intermittent 52%
Mild persistent 15%
Moderate persistent 20%
Severe persistent 13%
Demographics and Lower Use of Inhaled Anti-Inflammatory
Medications
OR P-value
Age <50 years 13.8 <.002
Lower education 3.9 <.05
Minority 7.9 <.005
Program Effects on Medication Use
1.Inhaled non-steroid use increased more in the 12 month follow up perceived in the treatment group (p=.09).
2. Significantly more reduction to use short-acting bronchodilators at 24 month follow up in treatment group (p=.05)
CONCLUSIONS
A. Women of lower education and younger age used less inhaled anti inflammatory medicine
B. The intervention improved medicine use over the evaluation period
