Long term effect of a self regulation education on inhaled anti-inflammatory


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Long term effect of a self regulation education on inhaled anti-inflammatory

Noreen M. Clark
Center for Managing Chronic Disease
University of Michigan

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  • Sex and gender related management issues were also studied including menstruation, PMS, sexual activity and household activities.
  • Data is collected via telephone in a 45 minute interview.
  • About 50% of the participants were between 41 and 60 years of age. Twenty percent were 60 years of age and older and the remaining one fourth were 40 years and younger. .
  • Twenty-six% of the participants were high school graduates, 21% reported completion of two-years of college, 30% completed 4-years of college, and 21% reported post graduate education.
  • Fourteen percent of the women have less than $20,000 annual household income. Thirteen % between 20,000 to 40,000. About 35% of the women reported in a range of 40,000 to 60,000 annual household income. 11% of the women did not report their income.
  • 17% of the participants are minorities. 10% African-American and 2% Hispanic. This is representative of the population served by the UM Health System.
  • Asthma severity was calculated using NAEPP criteria with 52% of the women were classified as having mild intermittent asthma while 48% had mild persistent to severe persistent asthma. 13% of the women were classified as severe persistent.
  • Long term effect of a self regulation education on inhaled anti-inflammatory

    1. 1. Noreen Clark, PhD Molly Gong, MD Julie Dodge, MS Sijian Wang, M.S. Xihong Lin, PhD William Bria, MD Timothy Johnson, MD Long Term Effect of A self-Regulation Education on Inhaled Anti-Inflammatory Medicines and Short-Acting Bronchodilator University of Michigan School of Public Health Supported by NHLBI grant 1 R18 HL60884
    2. 2. BACKGROUD <ul><li>Inhaled anti-inflammatory medicines are suggested for disease control in asthma patients (NAEPP). </li></ul><ul><li>Increasing use of short-acting bronchodilators indicates inadequate control of the disease (NAEPP). </li></ul>
    3. 3. PURPOSE <ul><li>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. </li></ul>
    4. 4. METHODS <ul><li>Recruitment </li></ul><ul><ul><li>Women 18 years and older </li></ul></ul><ul><ul><li>Physician diagnosis </li></ul></ul><ul><ul><li>Attending University of Michigan Asthma & Airways Clinic and University of Michigan Health System </li></ul></ul>
    5. 5. Data Collection <ul><li>Telephone interview </li></ul><ul><ul><li>Demographics </li></ul></ul><ul><ul><li>Asthma symptoms </li></ul></ul><ul><ul><li>Health care utilization </li></ul></ul><ul><ul><li>Gender-related management </li></ul></ul><ul><ul><li>Peak flow meter use </li></ul></ul>
    6. 6. Study Sample <ul><ul><li>Baseline 808 </li></ul></ul><ul><ul><li>Follow up I* 608 </li></ul></ul><ul><ul><li>Follow up II** 580 </li></ul></ul><ul><ul><li>One year subsequent to baseline data collection </li></ul></ul><ul><ul><li>One year subsequent to follow up I data collection </li></ul></ul>
    7. 7. Demographics: Age
    8. 8. Demographics: Education
    9. 9. Demographics: Income
    10. 10. Demographics: Race/Ethnicity
    11. 11. Intervention <ul><li>Subsequent to baseline data collection, women were randomly assigned to either the control or the intervention group. </li></ul><ul><li>Women in the intervention group received the self-regulation telephone counseling intervention: Women Breathe Free. </li></ul>
    12. 12. Data Analyses <ul><li>To examine: </li></ul><ul><li>Relationships between demographics vs. Medication use at baseline: Frequencies with Odds Ratio </li></ul><ul><li>Program effects on medication use: </li></ul><ul><li>Generalized Estimating Equations (GEE) with logit link using entire sample (intent-to-treat) </li></ul>
    13. 13. FINDINGS Asthma Severity Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, 1997 13% Severe persistent 20% Moderate persistent 15% Mild persistent 52% Mild intermittent Percent of Women
    14. 14. Demographics and Lower Use of Inhaled Anti-Inflammatory Medications <.005 7.9 Minority <.05 3.9 Lower education <.002 13.8 Age <50 years P-value OR
    15. 15. Program Effects on Medication Use <ul><li>1. Inhaled non-steroid use increased more in the 12 month follow up perceived in the treatment group (p=.09). </li></ul>
    16. 16. <ul><li>2. Significantly more reduction to use short-acting bronchodilators at 24 month follow up in treatment group (p=.05) </li></ul>
    17. 17. CONCLUSIONS <ul><li>Women of lower education and younger age used less inhaled anti inflammatory medicine </li></ul><ul><li>The intervention improved medicine use over the evaluation period </li></ul>