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Frey SM, Fagnano M, Halterman JS. Adolescent Knowledge of When to Use Inhaled Asthma Medications: Implications for Management. J Adolesc Health 2023; 72:623-628. [PMID: 36528520 PMCID: PMC10033387 DOI: 10.1016/j.jadohealth.2022.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/04/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE It is unclear how often adolescents with persistent asthma know when to use different inhaled medications (as-needed rescue vs. daily controller; 'accurate use'), or whether this knowledge is associated with clinical asthma outcomes. This study aimed to characterize adolescent knowledge of accurate use; examine whether accurate use is associated with controller medication adherence, asthma symptoms, or exacerbations requiring acute health care services; and determine whether knowledge of accurate use improves following regular exposure to controller medications with school-based directly observed therapy (DOT). METHODS We analyzed baseline and 7-month data from the School-Based Asthma Care for Teens trial. Adolescents (12-16 years) identified inhaled medications on a chart and stated when each is used. We compared accurate use with adolescent-reported adherence, recent symptoms, and asthma-related acute health care visits; and exposure to DOT. Analyses were limited to subjects with controller medication. RESULTS Of 430 participants, 252 had controller medication at baseline. Knowledge of accurate use was described by 62%, and associated with adherence (odds ratio [OR]: 2.06, 95% confidence interval [CI]: 1.12-3.83). By 7 months, 313 adolescents had controller medication; 75% described accurate use, which was associated with adherence (OR: 3.46, 95% CI: 1.83-6.54), health care (OR: 0.39, 95% CI: 0.20-0.79), and DOT exposure (OR: 1.83, 95% CI: 1.10-3.32). Associations with adherence and health care at 7 months persisted in adjusted analyses. DISCUSSION Adolescent knowledge of accurate medication use was linked with greater adherence (baseline, 7 months), less acute health care (7 months), and exposure to in-school DOT. Interventions to support adolescents with persistent asthma should consider school-based care strategies and facilitate adolescent understanding of when to use different medications.
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Affiliation(s)
- Sean M Frey
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Salinas GD, Wiley S, Stacy S, Gall R, Wright L, Mandarakas A, Ruiz-Cordell K, Gilbride J. Understanding decision-making and educational need in the management of pediatric patients with moderate-to-severe asthma: analysis of a US-based clinician survey. J Asthma 2022; 60:1171-1182. [PMID: 36251048 DOI: 10.1080/02770903.2022.2137037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Asthma creates a substantial burden on the pediatric healthcare system, particularly by those with moderate-to-severe disease. As few studies have been published specific to clinician evaluation and management of this population, this analysis serves to begin to identify educational needs and potential clinical impact. METHODS We conducted a case-based survey of US general pediatric (n = 227), allergy (n = 158), and pediatric pulmonology (n = 70) clinicians to understand the current approach to management of pediatric patients with moderate-to-severe asthma. RESULTS Results show inconsistencies in guideline adherence, identification of disease severity and control, referral practices, and knowledge of phenotypes, which may impact clinical decision making. While most clinicians refer to guidelines when managing pediatric patients with moderate-to-severe asthma, there is no preferred set, and they find the guidelines to be moderately useful. General pediatricians are more likely than specialists to have difficulty distinguishing control and severity and may not be familiar with the concept of asthma phenotype. Most surveyed pediatricians indicated they refer patients to a specialist, but did not always do so in the cases. Clinicians have little consensus on the best approach to manage patients with uncontrolled symptoms after optimized therapy. Many clinicians may have uncertainty about how elevated eosinophils or FeNO could affect patient management. Further, there may be gaps in incorporating parents and pediatric patients into shared decision-making in their care. CONCLUSIONS Understanding the needs of those managing patients with moderate-to-severe asthma is critical to developing effective continuing education activities to improve patient outcomes.
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Affiliation(s)
- Gregory D Salinas
- CE Outcomes LLC, NA, 2101 Highland Ave S, STE 300A, Birmingham, 35205-4009 United States
| | - Shereta Wiley
- CE Outcomes LLC, NA, 2101 Highland Ave S, STE 300A, Birmingham, 35205-4009 United States
| | - Sylvie Stacy
- CE Outcomes LLC, NA, 2101 Highland Ave S, STE 300A, Birmingham, 35205-4009 United States
| | - Rebecca Gall
- Regeneron Pharmaceuticals Inc, Medical Affairs, Tarrytown, 10591 United States
| | - Lakiea Wright
- Sanofi, Medical Affairs, Cambridge, 02142 United States
| | - Anthia Mandarakas
- Regeneron Pharmaceuticals Inc, Medical Affairs, Tarrytown, 10591 United States
| | - Karyn Ruiz-Cordell
- Regeneron Pharmaceuticals Inc, Medical Affairs, Tarrytown, 10591 United States
| | - Joseph Gilbride
- Regeneron Pharmaceuticals Inc, Medical Affairs, Tarrytown, 10591 United States
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Margolis RHF, Bellin MH, Morphew T, Tsoukleris M, Bollinger ME, Butz A. Caregiver Depressive Symptoms and Primary Medication Nonadherence in Children With Asthma. J Pediatr Health Care 2022; 36:136-143. [PMID: 34011445 PMCID: PMC8594280 DOI: 10.1016/j.pedhc.2021.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/22/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The purpose of this study was to identify risk factors for primary medication nonadherence among low-income minority children with persistent asthma. METHOD Data were from an environmental control and educational intervention for children with uncontrolled asthma who were treated in the emergency department for an asthma exacerbation. Presence or absence of pharmacy records for child asthma medications was the outcome of interest. A range of sociodemographic, health, and psychosocial measures were included in the binary logistic regression. RESULTS Of the 222 youths (mean age = 6.3 years; 93.7% Black), 25 (11.3%) lacked pharmacy records of asthma medications. For every 1-point increase in caregiver depressive symptoms, the odds of the child having a pharmacy record declined by 5% (odds ratio = 0.95; p = .012). DISCUSSION Providers should systematically assess and monitor caregiver depressive symptoms as a potential contributing factor for primary medication nonadherence in low-income minority children with persistent, uncontrolled asthma.
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Jones R, Turner B, Perera P, Hiscock H, Chen K. Understanding caregiver perspectives on challenges and solutions to pediatric asthma care for children with a previous hospital admission: a multi-site qualitative study. J Asthma 2021; 59:1973-1980. [PMID: 34569896 DOI: 10.1080/02770903.2021.1984528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Pediatric hospital admissions for asthma provide an opportunity to trigger a review of the current management with an aim of preventing readmissions. However, caregiver voices on how best to improve care are missing. METHODS As part of a larger, mixed methods cohort study, we identified caregivers of children aged 3-18 years who had an index hospital admission to a tertiary pediatric, mixed adult and pediatric, or regional hospital in Victoria, Australia, between 1st September 2017 and 31st August 2018 with a discharge diagnosis of "Asthma" or "Wheeze" based on International Classification of Disease-10 coding. We conducted qualitative semi-structured interviews with a purposive sample of 39 caregivers. We used content analysis to identify themes from the data. RESULTS Caregivers identified both challenges associated with asthma care for children with a previous hospital admission as well as solutions to improve care and potentially reduce readmissions. Key challenges included: unclear pathways for follow up care, inconsistent advice, lack of personalized management, delays in getting a diagnosis, delays in the prescription of a preventer medication, and difficulty accessing primary care during exacerbations. Follow up with an "asthma specialist", early access to a trial of preventer medication, personalized Written Asthma Action Plans and increased access to and quality of community-based asthma support services were identified as key solutions. CONCLUSIONS Caregivers have identified several potential solutions that could be implemented to improve care and possibly reduce pediatric asthma hospital readmissions. The challenge now is to co-design, embed and evaluate these in healthcare systems. Supplemental data for this article can be accessed at publisher's website.
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Affiliation(s)
- Renee Jones
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Brittany Turner
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Prescilla Perera
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Harriet Hiscock
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katherine Chen
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Australia
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Martin A, McDonald J, Holland J. Completeness of Medication Reconciliation Performed by Pediatric Resident Physicians at Hospital Admission for Asthma. Can J Hosp Pharm 2021; 74:30-35. [PMID: 33487652 PMCID: PMC7801341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Medication errors at hospital admission, though preventable, continue to be common. The process of medication reconciliation has been identified as an important tool in reducing medication errors. The first step in medication reconciliation involves documenting a patient's best possible medication history (BPMH); at the authors' tertiary pediatric hospital, this step is completed at time of admission by resident physicians. OBJECTIVES To describe and quantify the completeness of admission BPMH by resident physicians for pediatric inpatients with asthma. METHODS This single-centre, retrospective chart review evaluated documentation of admission medication reconciliation for pediatric inpatients with asthma who were admitted between January 2016 and December 2017. Medication reconciliation forms were deemed incomplete if records for asthma medications were missing drug name, inhaler strength or oral drug dose, directions for use, or evidence of reconciliation. RESULTS A total of 241 charts were evaluated, of which 97 (40%) had incomplete documentation for at least 1 medication; in particular, 48 (37%) of the 130 inhaled corticosteroid orders were missing inhaler strength. For most of the charts with incomplete medication history (68% [66/97]), no reason was documented; however, review of the medication reconciliation forms and physician notes revealed that families might have been unsure of a patient's home medications or physicians might have left it to the pharmacy to clarify medication doses. CONCLUSIONS Documentation of inhaler medications on admission medication reconciliation forms completed by resident physicians for pediatric patients with asthma was often incomplete. Future quality improvement interventions, including resident and patient education, are required at the study institution. Collaboration with pharmacy services is also likely to improve completeness of the medication reconciliation process.
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Affiliation(s)
- Ashley Martin
- , MD, FRCPC, is a Pediatric Emergency Medicine Resident at Dalhousie University, Halifax, Nova Scotia
| | - Jaime McDonald
- , PharmD, is a Pharmacist with the IWK Health Centre, Halifax, Nova Scotia
| | - Joanna Holland
- , MD, FRCPC, is Assistant Professor in the Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
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Prather SL, Foronda CL, Kelley CN, Nadeau C, Prather K. Barriers and Facilitators of Asthma Management as Experienced by African American Caregivers of Children with Asthma: An Integrative Review. J Pediatr Nurs 2020; 55:40-74. [PMID: 32653828 DOI: 10.1016/j.pedn.2020.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION African American children with asthma demonstrate significant health disparities and poor health outcomes. Understanding the burdens faced by parents and caregivers of children with asthma may be helpful to develop future interventions to address this disparity. PURPOSE The purpose of this integrative review was to reveal the barriers and facilitators of child asthma management experienced by African American caregivers. METHOD Whittemore and Knafl's (2005) method of integrative review was used to review 40 articles. The integrative review involved appraising the quality of the literature, conducting a thematic analysis, and evaluating the barriers and facilitators of pediatric asthma management experienced by African American caregivers. RESULTS Barriers and facilitators were identified as themes. Barriers included caregiver burdens, and lack of home and neighborhood safety. Facilitators were family and community support, education and empowerment, and culturally competent healthcare providers. DISCUSSION To improve the care of African American children with asthma, nurses should work to engage, communicate, and foster trust with families. Nurses should assess and address the family caregivers' burdens while emphasizing support systems.
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Affiliation(s)
- Susan L Prather
- University of Miami, School of Nursing and Health Studies, FL, United States of America.
| | - Cynthia L Foronda
- University of Miami, School of Nursing and Health Studies, FL, United States of America.
| | - Courtney N Kelley
- University of Miami, School of Nursing and Health Studies, FL, United States of America.
| | - Catherine Nadeau
- University of Miami, School of Nursing and Health Studies, FL, United States of America.
| | - Khaila Prather
- Department of Public Health Sciences, University of Miami Miller School of Medicine, FL, United States of America.
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Foronda CL, Kelley CN, Nadeau C, Prather SL, Lewis-Pierre L, Sarik DA, Muheriwa SR. Psychological and Socioeconomic Burdens Faced by Family Caregivers of Children With Asthma: An Integrative Review. J Pediatr Health Care 2020; 34:366-376. [PMID: 32299726 DOI: 10.1016/j.pedhc.2020.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Asthma affects nearly 1 in every 12 children in the United States. Caring for a child with asthma poses significant challenges for the parent or caregiver. The purpose of this integrative review was to identify the psychological and socioeconomic burdens faced by family caregivers of children with asthma. METHOD An integrative review was conducted to review and appraise 80 studies. RESULTS Psychosocial burdens included decreased mental health, quality of life, sleep, family stress, educational deficits, cultural and health disparities, and health care communication challenges. Socioeconomic burdens included poor access to care, as well as work and financial challenges. Studies demonstrated a link between family caregiver health and child health outcomes. Facilitators included education and empowerment, social support, and use of technology. DISCUSSION As the family caregiver's health directly affects the asthmatic child's health, addressing the burdens of family caregivers should be a key consideration in pediatric asthma care.
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Frey SM, Contento NC, Halterman JS. Nurse-delivered outpatient asthma education for children and caregivers: a pilot study to promote shared asthma management. J Asthma 2019; 58:413-421. [PMID: 31739709 DOI: 10.1080/02770903.2019.1692028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the feasibility of nurse-delivered asthma education for caregiver/child dyads in a busy clinic setting, and measure the preliminary effectiveness of the intervention. METHODS We conducted a pilot study of nurse-delivered asthma education in a busy outpatient clinic. We enrolled a convenience sample of children (7-16 years) with uncontrolled persistent asthma who had a prescription for an inhaled controller medication and public health insurance. After provider visits, nurses taught dyads using picture-based materials, teach-back methods, and colored labels applied to asthma medications. The intervention was repeated at 1-month follow-up. We assessed feasibility by reviewing nurse documentation in the electronic medical record, detailing whether each component was implemented and the time required for education at each visit. We measured preliminary effectiveness by surveying children and caregivers separately before each clinic visit about asthma management responsibility, self-efficacy, caregiver quality of life, and symptoms; caregivers also completed a final telephone survey 2 months after the follow-up visit. We examined pre-post differences in continuous outcomes within-subjects using Wilcoxon signed rank tests. RESULTS We enrolled 22 child/caregiver dyads. Nursing documentation indicated a high rate of component delivery at each visit; the initial and 1-month visits required 25 and 15 min, respectively. We observed significant increases in child responsibility, child/caregiver self-efficacy, caregiver quality of life, and child symptoms at each follow-up. CONCLUSION This intervention of patient-centered asthma education can be delivered by nurses to caregiver/child dyads with high fidelity in a busy pediatric practice. Preliminary data indicate potential benefit for both children and caregivers.
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Affiliation(s)
- Sean M Frey
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Nicholas C Contento
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Frey SM, Jones MR, Goldstein NPN, Fagnano M, Halterman JS. Comparing inhaled medications reported by adolescents with persistent asthma and their caregivers. J Asthma 2019; 57:999-1005. [PMID: 31264485 DOI: 10.1080/02770903.2019.1631342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To compare concordance (agreement) between teens with persistent asthma and their caregivers on the reported number of inhaled asthma medications used (rescue and controller); examine concordance specific to controller medications; and determine whether concordance over controller medications within caregiver/teen dyads is associated with demographics or clinical outcomes.Methods: We used baseline data from the School-Based Asthma Care for Teens (SB-ACT) trial in urban Rochester, NY. Caregivers and teens (12-16 yrs.) with poorly controlled persistent asthma separately reported the teens' inhaled therapy, and could name up to two rescue and two controller medications. We compared the total number of medications and number of controller medications reported by each dyad member with Cohen's Kappa, and assessed whether concordance over the number of controller medications was associated with demographics, symptoms, or healthcare utilization using chi-square and t-tests.Results: Of 210 dyads (79% public health insurance, 61% Black teens), 132 (63%) were disconcordant in reporting the overall number of inhaled medications. Teens or caregivers from 173 dyads (82%) reported any controller medication; however, a majority (61%) were discordant in the reporting of controller medications. Compared with concordant dyads, fewer caregivers from dyads with controller medication discordance reported education past high school (35% vs. 51%, p = 0.04); no other differences in demographics, symptoms, or healthcare utilization were identified based on controller medication concordance.Conclusions: Most dyads identified different numbers of inhaled medications, with substantial disagreement over controller medications. Working to ensure a basic understanding of treatment plans may promote successful self-management in persistent childhood asthma.
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Affiliation(s)
- Sean M Frey
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Marybeth R Jones
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | | | - Maria Fagnano
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Jill S Halterman
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
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Medication administration by caregiving youth: An inside look at how adolescents manage medications for family members. J Adolesc 2018; 69:33-43. [PMID: 30223151 DOI: 10.1016/j.adolescence.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Children take on the role of family caregiver throughout the world. No prior published research exists surrounding the particular circumstances of the task of medication administration and management by these youth, which was explored in this study. METHODS A series of focus groups were conducted using semi-structured interviews of 28 previously identified caregiving youth ages 12-19 years old who live in the United States. Data analysis followed guidelines of conventional content analysis. RESULTS The following categories emerged about youth caregivers handling medications: 1) tasks involve organizational and administrative responsibilities; 2) youth have varying degrees of knowledge pertaining to these medications; 3) most share responsibility with other family members; 4) they lack formal education about their responsibilities; 5) multiple challenges exist relating to this task; 6) managing medications is associated with emotional responses; and 7) possible safety issues exist. CONCLUSIONS These responsibilities represent a unique hardship and merit support and research from the medical, healthcare, legislative, and public health communities, among others.
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Callaghan-Koru JA, Riekert KA, Ruvalcaba E, Rand CS, Eakin MN. Home Medication Readiness for Preschool Children With Asthma. Pediatrics 2018; 142:peds.2018-0829. [PMID: 30087197 PMCID: PMC6317646 DOI: 10.1542/peds.2018-0829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Having a medication available in the home is a prerequisite to medication adherence. Our objectives with this study are to assess asthma medication readiness among low-income urban minority preschool-aged children, and the association between beliefs about medications and medication readiness. METHODS During a baseline assessment, a research assistant visited the home to administer a caregiver survey and observe 5 criteria in the medication readiness index: the physical presence and expiration status of medications, the counter status of metered-dose inhalers, and caregiver knowledge of medication type and dosing instructions. RESULTS Of 288 enrolled children (mean age 4.2 years [SD: 0.7], 92% African American, 60% boys), 277 (96%) of their caregivers reported a rescue medication, but only 79% had it in the home, and only 60% met all 5 of the medication readiness criteria. Among the 161 children prescribed a controller medication, only 79% had it in the home, and only 49% met all 5 readiness criteria. Fewer worries and concerns about medications were associated with higher odds of meeting all 5 readiness criteria for controller medications. CONCLUSIONS Inadequate availability of asthma medications in the home is a barrier to adherence among low-income urban preschoolers. Assessment of medication readiness should be incorporated into clinical care because this is an underrecognized barrier to adherence, and interventions are needed to improve medication management and knowledge to increase adherence.
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Affiliation(s)
- Jennifer A. Callaghan-Koru
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, Maryland; and
| | - Kristin A. Riekert
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth Ruvalcaba
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Cynthia S. Rand
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Gray WN, Netz M, McConville A, Fedele D, Wagoner ST, Schaefer MR. Medication adherence in pediatric asthma: A systematic review of the literature. Pediatr Pulmonol 2018; 53:668-684. [PMID: 29461017 DOI: 10.1002/ppul.23966] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To provide a systematic review of correlates of adherence to inhaled corticosteroids (ICS) in pediatric asthma across the individual, family, community, and healthcare system domains. METHODS Articles assessing medication adherence in pediatric asthma published from 1997 to 2016 were identified using PsychINFO, Medline, and CINAHL. Search terms included asthma, compliance, self-management, adherence, child, and youth. Search results were limited to articles: 1) published in the US; 2) using a pediatric population (0-25 years old); and 3) presenting original data related to ICS adherence. Correlates of adherence were categorized according to the domains of the Pediatric Self-Management Model. Each article was evaluated for study quality. RESULTS Seventy-nine articles were included in the review. Family-level correlates were most commonly reported (N = 51) and included socioeconomic status, race/ethnicity, health behaviors, and asthma knowledge. Individual-level correlates were second-most common (N = 37), with age being the most frequently identified negative correlate of adherence. Health care system correlates (N = 24) included enhanced asthma care and patient-provider communication. Few studies (N = 10) examined community correlates of adherence. Overall study quality was moderate, with few quantitative articles (26.38%) and qualitative articles (21.4%) referencing a theoretical basis for their studies. CONCLUSIONS All Pediatric Self-Management Model domains were correlated with youth adherence, which suggests medication adherence is influenced across multiple systems; however, most studies assessed adherence correlates within a single domain. Future research is needed that cuts across multiple domains to advance understanding of determinants of adherence.
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Affiliation(s)
- Wendy N Gray
- Department of Psychology, Auburn University, Auburn University, AL
| | - Mallory Netz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Andrew McConville
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - David Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Scott T Wagoner
- Department of Psychology, Auburn University, Auburn University, AL
| | - Megan R Schaefer
- Department of Psychology, Auburn University, Auburn University, AL
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Frey SM, Jones MR, Goldstein N, Riekert K, Fagnano M, Halterman JS. Knowledge of Inhaled Therapy and Responsibility for Asthma Management Among Young Teens With Uncontrolled Persistent Asthma. Acad Pediatr 2018; 18:317-323. [PMID: 29369804 PMCID: PMC5903444 DOI: 10.1016/j.acap.2018.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/22/2017] [Accepted: 01/06/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To compare the abilities of teens with uncontrolled persistent asthma and their caregivers to identify inhaled medications and state correct indications for use; examine medication responsibility within dyads; and determine whether responsibility is associated with knowledge about inhaled therapies. METHODS In the baseline survey for the School-Based Asthma Care for Teens (SB-ACT) trial, we separately asked caregivers and teens to: 1) identify the teen's inhaled asthma therapies by name and from a picture chart (complete matches considered "concordant"); 2) describe indications of use for each medication; and 3) describe the allocation of responsibility for medication use within dyads. We limited analyses to dyads in which either member reported at least one rescue and one inhaled controller medication; we used McNemar and Pearson chi-square tests. RESULTS A total of 136 dyads were analyzed. More caregivers than teens concordantly identified medications (63% vs 31%, P < .001). There was no difference between caregivers and teens in the ability to state correct indications for use (56% vs 54%, P = .79). More teens than caregivers endorsed "full teen responsibility" for rescue medication (65% vs 27%, P < .001) and controller medication use (50% vs 15%, P < .001). Neither concordant identification nor knowing indications for use was associated with reported medication responsibility. CONCLUSIONS Medication responsibility within dyads of caregivers and teens with persistent asthma is not associated with knowledge about inhaled therapies. Targeting both members of the dyad with education and self-management strategies before responsibility transitions start may allow providers to avoid a missed opportunity to support these emerging stakeholders to adherence.
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Affiliation(s)
- Sean M. Frey
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Marybeth R. Jones
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Nicolas Goldstein
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Maria Fagnano
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jill S. Halterman
- University of Rochester School of Medicine and Dentistry, Rochester, NY
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Carr TF, Kraft M. Management of Severe Asthma before Referral to the Severe Asthma Specialist. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2017; 5:877-886. [PMID: 28689838 PMCID: PMC5526085 DOI: 10.1016/j.jaip.2017.04.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 12/26/2022]
Abstract
Severe asthma is associated with significant morbidity and can be challenging to assess and control, due to heterogeneity of disease, complexity of diagnosis, and impact of comorbidities. A structured approach to the assessment and management of severe asthma may be helpful to the practicing clinician. First, it is important to confirm a diagnosis of asthma. In patients who are either not responding to treatment, or who require high doses of medication to control symptoms, it is highly possible that disease mimickers or comorbidities are present and can inhibit therapeutic responsiveness. The assessment and management of common comorbidities of asthma may dramatically impact disease control and thus medication requirement. Determining medication adherence and optimizing drug dose and delivery may separate out truly severe asthmatics from those not using medications regularly or properly. Next, although true personalized medicine for severe asthma is not yet realized, for those individuals with severe asthma, phenotypic characteristics of each patient may guide which therapeutic options may be most effective for that patient. Finally, evaluation and management of severe asthma at a referral center can add additional phenotyping, therapeutic, and diagnostic strategies.
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Affiliation(s)
- Tara F Carr
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz.
| | - Monica Kraft
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
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15
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Lemanske RF, Kakumanu S, Shanovich K, Antos N, Cloutier MM, Mazyck D, Phipatanakul W, Schantz S, Szefler S, Vandlik R, Williams P. Creation and implementation of SAMPRO™: A school-based asthma management program. J Allergy Clin Immunol 2017; 138:711-723. [PMID: 27596707 PMCID: PMC5085063 DOI: 10.1016/j.jaci.2016.06.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 05/23/2016] [Accepted: 06/03/2016] [Indexed: 11/25/2022]
Abstract
Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a “circle of support” that would enhance multidirectional communication and promote better care for children with asthma within the school setting.
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Affiliation(s)
- Robert F Lemanske
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Sujani Kakumanu
- University of Wisconsin School of Medicine and Public Health and the Middleton Memorial Veteran's Hospital, Madison, Wis
| | - Kathleen Shanovich
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Nicholas Antos
- Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wis
| | - Michelle M Cloutier
- Department of Pediatrics, University of Connecticut Health Center, Farmington, and the Asthma Center, CT Children's Medical Center, Hartford, Conn
| | - Donna Mazyck
- National Association of School Nurses, Silver Spring, Md
| | - Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, Harvard Medical School, Boston, Mass
| | | | - Stanley Szefler
- Children's Hospital Colorado, the Breathing Institute, and Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Renee Vandlik
- American Academy of Allergy, Asthma & Immunology, Milwaukee, Wis
| | - Paul Williams
- Department of Pediatrics, University of Washington School of Medicine, Allergist, NW Asthma & Allergy Center, Seattle, Wash
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16
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Rangachari P. A framework for measuring self-management effectiveness and health care use among pediatric asthma patients and families. J Asthma Allergy 2017; 10:111-122. [PMID: 28442924 PMCID: PMC5396924 DOI: 10.2147/jaa.s133481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Asthma is associated with substantial health care expenditures, including an estimated US$56 billion per year in direct costs. A recurring theme in the asthma management literature is that costly asthma symptoms, including hospitalizations and multiple emergency department (ED)/outpatient visits, can often be prevented through patient/family adherence to the national (National Institutes of Health Expert Panel Report-3) guidelines for effective self-management of asthma, specifically 1) medication adherence and 2) environmental trigger avoidance, as outlined in the patient's personalized Asthma-Action Plan. It is important to note however that while effective self-management of asthma is known to reduce ED visits and hospitalizations, the relationship between asthma self-management effectiveness and outpatient visit frequency remains ambiguous, reflecting a gap in the literature. For instance, do patients/families who self-manage effectively visit outpatient clinics more frequently for asthma care (compared to those who do not self-manage effectively), after accounting for differences in asthma severity, demographic characteristics, and risk factors? Do patients/families who visit outpatient clinics more frequently for asthma care, in turn have fewer ED and inpatient encounters for asthma? On the other hand, do patients/families who do not revisit outpatient clinics regularly have higher ED visits and hospitalizations? It is important to address these gaps, in order to reduce the costs and public health burden of asthma. This paper provides a foundation for addressing these gaps, by conducting an integrative review of the asthma management literature, to develop a conceptual framework for measuring self-management effectiveness and health care use among pediatric asthma patients/families. In doing so, the paper lays the groundwork for future research seeking to explicate the relationship between asthma self-management effectiveness and health care use, which in turn has potential to engage asthma providers in promoting ideal self-management and optimal health care use for pediatric asthma, in accordance with national evidence-based guidelines for asthma management.
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Affiliation(s)
- Pavani Rangachari
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
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