改善城市黑人哮喘控制的定制简短共同决策分组随机试验

Aims To assess the intervention effects of BREATHE (BRief intervention to Evaluate Asthma THErapy), a novel brief shared decision‐making intervention and evaluate feasibility and acceptability of intervention procedures. Design Group‐randomized longitudinal pilot study. Methods In total, 80 adults with uncontrolled persistent asthma participated in a trial comparing BREATHE ( N  = 40) to a dose‐matched attention control intervention ( N  = 40). BREATHE is a one‐time shared decision‐making intervention delivered by clinicians during routine office visits. Ten clinicians were randomized and trained on BREATHE or the control condition. Participants were followed monthly for 3 months post‐intervention. Data were collected from December 2017 – May 2019 and included surveys, lung function tests, and interviews. Results Participants were Black/multiracial (100%) mostly female (83%) adults (mean age 45). BREATHE clinicians delivered BREATHE to all 40 participants with fidelity based on expert review of audiorecordings. While the control group reported improvements in asthma control at 1‐month and 3‐month follow‐up, only BREATHE participants had better asthma control at each timepoint (β = 0.77; standard error ( SE )[0.17]; p  ≤ 0.0001; β = 0.71; SE[0.16]; p  ≤ 0.0001; β = 0.54; SE [0.15]; p  = .0004), exceeding the minimally important difference. BREATHE participants also perceived greater shared decision‐making occurred during the intervention visit (β = 7.39; SE [3.51]; p  = .03) and fewer symptoms at follow‐up (e.g., fewer nights woken, less shortness of breath and less severity of symptoms) than the controls. Both groups reported improved adherence and fewer erroneous medication beliefs. Conclusion BREATHE is a promising brief tailored intervention that can be integrated into office visits using clinicians as interventionists. Thus, BREATHE offers a pragmatic approach to improving asthma outcomes and shared decision‐making in a health disparity population. Impact The study addressed the important problem of uncontrolled asthma in a high‐risk vulnerable population. Compared with the dose‐matched attention control condition, participants receiving the novel brief tailored shared decision‐making intervention had significant improvements in asthma outcomes and greater perceived engagement in shared decision‐making. Brief interventions integrated into office visits and delivered by clinicians may offer a pragmatic approach to narrowing health disparity gaps. Future studies where other team members (e.g., office nurses, social workers) are trained in shared decision‐making may address important implementation science challenges as it relates to adoption, maintenance, and dissemination. Trail registration clinicaltrials.gov # NCT03300752.