Construction And Effect Evaluation Of Integrated Management Model Of Asthma Children

Objective: A qualitative research and questionnaire survey was conducted to investigate the problems on the self-management of asthmatic children and the needs for family health services in order to provide. And to investigate the influence of integrated management model to asthma childhood health assessment indicators and the others indicators through combination of standard hospital management and self-management of asthma child family. To form a scientific, feasible and effective asthma children integrated management mode, in order to improve asthma child family self-management and hospital management level. Methods:We interviewed fourteen caregivers of children with asthma with open-ended questions.Using Colaizzi seven-step method of phenomenologica1 analysis to study the collected data; 209 children with asthma were divided into 2 groups with Morisky Medication Adherence Scale 8-item: nonadherence group and adherence group. Univariate and binary regression analysis was used to compare the difference of 19 indicators including PLOC and ages 、 the mastery of inhalation technique and so on between the two group to find out the main factors influencing the medication adherence; Combined with own management experience and the requirement of GINA, constructs the asthma children integrated management mode.86 children with asthma were enrolled and divided in a random way into 2 groups:family-management group(A) and integrated management group(B),and then received treatment 6 months respectively. The C-ACT score, FEV1%,PEF%,Fe NO,MMAS-8score, onset times, emergency times and absence days were compared between two groups. Results: The problems of family management and the needs for family health services were shown as follows:insufficient knowledge to prevention and treatment of asthma,lack of targeted、continuing treatment plan,poor family routine,mental overload needs of supporting from hospital and social; According to the univariate analysis, the age、course of the disease、income of the family、education level of the main caregivers、the parents knowledge、the mastery of inhalation technique、the use of peak flow meter、worry about the side effect、onset times、emergency times and PLOC were differentbetween the two groups(P<0.01). The binary regression analysis shows that the parents knowledge 、 factor 3 and 5 of PLOC were the main factors which influencing the medication adherence(P<0.01); After management, the control level, FEV1%、PEF%and MMAS-8 score of group B was better than group A(P<0.05). Fe NO of group B was lower than group A(P<0.05). The onset times, emergency times and absence days of group B was less than group A(P<0.05). But the any indications of group A has no change(P>0.05). Conclusion: It is important to know the problem and needs of every family. We must make targeted plan for family self-management and provide psychology and social support for caregivers and encourage them to participate in the design of medical program for asthmatic children. The knowledge of the parents and the management of children were important for improving the medication adherence. We should strengthen the asthma children family psychological and social support, take more effective management strategies and method. The control level 、 lung function and adherence can be improved through integrated management. It is helpful to improve management level via medical institution managing asthma childhood with integrated management.