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Skene I, Kinley E, Pike K, Griffiths C, Pfeffer P, Steed L. Understanding interventions delivered in the emergency department targeting improved asthma outcomes beyond the emergency department: an integrative review. BMJ Open 2023; 13:e069208. [PMID: 37550032 PMCID: PMC10407367 DOI: 10.1136/bmjopen-2022-069208] [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: 10/20/2022] [Accepted: 06/14/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES The emergency department (ED) represents a place and moment of opportunity to provide interventions to improve long-term asthma outcomes, but feasibility, effectiveness and mechanisms of impact are poorly understood. We aimed to review the existing literature on interventions that are delivered in the ED for adults and adolescents, targeting asthma outcomes beyond the ED, and to code the interventions according to theory used, and to understand the barriers and facilitators to their implementation. METHODS We systematically searched seven electronic databases and research registers, and manually searched reference lists of included studies and relevant reviews. Both quantitative and qualitative studies that reported on interventions delivered in the ED which aimed to improve asthma outcomes beyond management of the acute exacerbation, for adolescents or adults were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool and informed study interpretation. Theory was coded using the Theoretical Domains Framework. Findings were summarised by narrative synthesis. RESULTS 12 articles were included, representing 10 unique interventions, including educational and medication-based changes (6 randomised controlled trials and 4 non-randomised studies). Six trials reported statistically significant improvements in one or more outcome measures relating to long-term asthma control, including unscheduled healthcare, asthma control, asthma knowledge or quality of life. We identified limited use of theory in the intervention designs with only one intervention explicitly underpinned by theory. There was little reporting on facilitators or barriers, although brief interventions appeared more feasible. CONCLUSION The results of this review suggest that ED-based asthma interventions may be capable of improving long-term outcomes. However, there was significant variation in the range of interventions, reported outcomes and duration of follow-up. Future interventions would benefit from using behaviour change theory, such as constructs from the Theoretical Domains Framework. PROSPERO REGISTRATION NUMBER CRD 42020223058.
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Affiliation(s)
- Imogen Skene
- Wolfson Institute of Population Health, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
| | - Emma Kinley
- Asthma UK Centre for Applied Research, Edinburgh, UK
| | | | - Chris Griffiths
- Wolfson Institute of Population Health, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
| | - Paul Pfeffer
- Wolfson Institute of Population Health, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
- Barts Health NHS Trust, London, UK
| | - Liz Steed
- Wolfson Institute of Population Health, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
- Asthma UK Centre for Applied Research, Edinburgh, UK
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Butz AM, Bollinger ME, Ogborn J, Morphew T, Mudd SS, Kub JE, Bellin MH, Lewis-Land C, DePriest K, Tsoukleris M. Children with poorly controlled asthma: Randomized controlled trial of a home-based environmental control intervention. Pediatr Pulmonol 2019; 54:245-256. [PMID: 30614222 PMCID: PMC6408727 DOI: 10.1002/ppul.24239] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/08/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Few trials have tested targeted environmental control (EC) interventions based on biomarkers of second hand smoke (SHS) exposure and allergen sensitization in reducing asthma emergency department (ED) visits in children with poorly controlled asthma. METHODS Overall, 222 children with poorly controlled asthma were randomized into a home-based EC intervention (INT) or control (CON) group and followed for ED visits over 12 months. All children received allergen-specific IgE serologic testing and SHS exposure biomarker testing to inform the EC intervention. Pharmacy data was examined for asthma medication fills. Cox proportional hazards and multivariate regression models were performed to examine factors associated with repeat ED visits. RESULTS There was no difference in increased risk of >1 ED visit at 12 months between INT and CON groups. Most children (75%) had moderate/severe persistent asthma. Over half (56%) had SHS exposure and 83% tested positive for >1 allergen sensitization. Among children without SHS exposure, the median time to first recurrent ED visit differed by group (CON: 195; INT: >365 days) after adjusting for child age, allergic sensitization, medication fills prior to baseline, controller medication use, and the interaction between group status and SHS exposure. Children who had positive allergic sensitizations, younger, had increased controller medication use and randomized to the CON group and had no SHS exposure had increased risk for a repeat ED visit over 12 months. CONCLUSIONS In this study, a home-based EC intervention was not successful in reducing asthma ED revisits in children with poorly controlled asthma with SHS exposure. Allergic sensitization, young age, and increased controller medication use were important predictors of asthma ED visits.
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Affiliation(s)
- Arlene Manns Butz
- Division of General Pediatrics and Adolescent Medicine, Baltimore, Maryland.,The Johns Hopkins University School of Nursing, University of Maryland, Baltimore, Maryland
| | - Mary E Bollinger
- School of Medicine, Department of Pediatrics, Baltimore, Maryland
| | - Jean Ogborn
- Department of Pediatric Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Shawna S Mudd
- The Johns Hopkins University School of Nursing, University of Maryland, Baltimore, Maryland
| | - Joan E Kub
- Department of Nursing, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California.,University of Maryland, Baltimore, Maryland
| | - Melissa H Bellin
- School of Social Work, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cassia Lewis-Land
- Division of General Pediatrics and Adolescent Medicine, Baltimore, Maryland
| | - Kelli DePriest
- The Johns Hopkins University School of Nursing, University of Maryland, Baltimore, Maryland
| | - Mona Tsoukleris
- The School of Pharmacy, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Lambert SD, Beatty L, McElduff P, Levesque JV, Lawsin C, Jacobsen P, Turner J, Girgis A. A systematic review and meta-analysis of written self-administered psychosocial interventions among adults with a physical illness. PATIENT EDUCATION AND COUNSELING 2017; 100:2200-2217. [PMID: 28734559 DOI: 10.1016/j.pec.2017.06.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/19/2017] [Accepted: 06/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The cost of implementing professionally-led psychosocial interventions has limited their integration into routine care. To enhance the translation of effective psychosocial interventions in routine care, a self-administered format is sometimes used. The meta-analysis examined the efficacy of written self-administered, psychosocial interventions to improve outcomes among individuals with a physical illness. METHODS Studies comparing a written self-administered intervention to a control group were identified through electronic databases searching. Pooled effect sizes were calculated across follow-up time points using random-effects models. Studies were also categorised according to three levels of guidance (self-administered, minimal contact, or guided) to examine the effect of this variable on outcomes. RESULTS Forty manuscripts were retained for the descriptive review and 28 for the meta-analysis. Findings were significant for anxiety, depression, distress, and self-efficacy. Results were not significant for quality of life and related domains as well as coping. Purely self-administered interventions were efficacious for depression, distress, and self-efficacy; only guided interventions had an impact on anxiety. CONCLUSIONS Findings showed that written self-administered interventions show promise across a number of outcomes. PRACTICE IMPLICATIONS Self-administered interventions are a potentially efficacious and cost-effective approach to address some of the most common needs of patients with a physical illness.
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Affiliation(s)
- Sylvie D Lambert
- Ingram School of Nursing, McGill University, Wilson Hall, 3506 University Street, Montreal, H3A 2A7, Canada; Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, The University of New South Wales, Liverpool, Australia(1); St. Mary's Research Centre.
| | - Lisa Beatty
- School of Psychology, Flinders University, Adelaide, Australia
| | - Patrick McElduff
- School of Medicine and Public Health, The University of Newcastle, HMRI building, John Hunter Hospital Campus, New Lambton Heights, Australia
| | - Janelle V Levesque
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, The University of New South Wales, Liverpool, Australia(1)
| | - Catalina Lawsin
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Paul Jacobsen
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Jane Turner
- Mental Health Centre, The University of Queensland, Herston, Australia
| | - Afaf Girgis
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, The University of New South Wales, Liverpool, Australia(1)
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Pinnock H, Parke HL, Panagioti M, Daines L, Pearce G, Epiphaniou E, Bower P, Sheikh A, Griffiths CJ, Taylor SJC. Systematic meta-review of supported self-management for asthma: a healthcare perspective. BMC Med 2017; 15:64. [PMID: 28302126 PMCID: PMC5356253 DOI: 10.1186/s12916-017-0823-7] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/20/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Supported self-management has been recommended by asthma guidelines for three decades; improving current suboptimal implementation will require commitment from professionals, patients and healthcare organisations. The Practical Systematic Review of Self-Management Support (PRISMS) meta-review and Reducing Care Utilisation through Self-management Interventions (RECURSIVE) health economic review were commissioned to provide a systematic overview of supported self-management to inform implementation. We sought to investigate if supported asthma self-management reduces use of healthcare resources and improves asthma control; for which target groups it works; and which components and contextual factors contribute to effectiveness. Finally, we investigated the costs to healthcare services of providing supported self-management. METHODS We undertook a meta-review (systematic overview) of systematic reviews updated with randomised controlled trials (RCTs) published since the review search dates, and health economic meta-analysis of RCTs. Twelve electronic databases were searched in 2012 (updated in 2015; pre-publication update January 2017) for systematic reviews reporting RCTs (and update RCTs) evaluating supported asthma self-management. We assessed the quality of included studies and undertook a meta-analysis and narrative synthesis. RESULTS A total of 27 systematic reviews (n = 244 RCTs) and 13 update RCTs revealed that supported self-management can reduce hospitalisations, accident and emergency attendances and unscheduled consultations, and improve markers of control and quality of life for people with asthma across a range of cultural, demographic and healthcare settings. Core components are patient education, provision of an action plan and regular professional review. Self-management is most effective when delivered in the context of proactive long-term condition management. The total cost (n = 24 RCTs) of providing self-management support is offset by a reduction in hospitalisations and accident and emergency visits (standard mean difference 0.13, 95% confidence interval -0.09 to 0.34). CONCLUSIONS Evidence from a total of 270 RCTs confirms that supported self-management for asthma can reduce unscheduled care and improve asthma control, can be delivered effectively for diverse demographic and cultural groups, is applicable in a broad range of clinical settings, and does not significantly increase total healthcare costs. Informed by this comprehensive synthesis of the literature, clinicians, patient-interest groups, policy-makers and providers of healthcare services should prioritise provision of supported self-management for people with asthma as a core component of routine care. SYSTEMATIC REVIEW REGISTRATION RECURSIVE: PROSPERO CRD42012002694 ; PRISMS: PROSPERO does not register meta-reviews.
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Affiliation(s)
- Hilary Pinnock
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Hannah L. Parke
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Maria Panagioti
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Luke Daines
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Gemma Pearce
- Centre for Technology Enabled Health Research (CTEHR), Coventry University, Coventry, UK
| | - Eleni Epiphaniou
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Chris J. Griffiths
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie J. C. Taylor
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Yorke J, Fleming S, Shuldham C, Rao H, Smith HE. Nonpharmacological interventions aimed at modifying health and behavioural outcomes for adults with asthma: a critical review. Clin Exp Allergy 2016; 45:1750-64. [PMID: 25675860 DOI: 10.1111/cea.12511] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evidence suggests that living with asthma is linked with psychological and behavioural factors including self-management and treatment adherence, and therefore, there is a reasonable hypothesis that nonpharmacological treatments may improve health outcomes in people living with this condition. A systematic review of randomized controlled trials (RCTs) of nonpharmacological interventions for adults with asthma was designed. Databases searched included The Cochrane Airways Group Register of trials, CENTRAL and Psychinfo. The literature search was conducted until May 2014. Twenty-three studies met the inclusion criteria and were organized into four groups: relaxation-based therapies (n = 9); mindfulness (n = 1), biofeedback techniques (n = 3); cognitive behavioural therapies (CBT) (n = 5); and multicomponent interventions (n = 5). A variety of outcome measures were used, even when trials belonged to the same grouping, which limited the ability to conduct meaningful meta-analyses. Deficiencies in the current evidence base, notably trial heterogeneity, means that application to clinical practice is limited and clear guidelines regarding the use of nonpharmacological therapies in asthma is limited. Relaxation and CBT, however, appear to have a consistent positive effect on asthma-related quality of life and some psychological outcomes, and lung function (relaxation only). Future trials should be informed by previous work to harmonize the interventions under study and outcome measures used to determine their effectiveness; only then will meaningful meta-analyses inform clinical practice.
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Affiliation(s)
- J Yorke
- Nursing, University of Manchester, Manchester, UK
| | - S Fleming
- Nursing Research, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - C Shuldham
- Nursing and Quality, Royal Brompton and Harefield Foundation Trust, London, UK
| | - H Rao
- Public Health and Primary Care, University of Brighton, Brighton, UK
| | - H E Smith
- Public Health and Primary Care, University of Brighton, Brighton, UK
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Boulet LP. Asthma education: an essential component in asthma management. Eur Respir J 2016; 46:1262-4. [PMID: 26521279 DOI: 10.1183/13993003.01303-2015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
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7
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Nurmagambetov T, Khavjou O, Murphy L, Orenstein D. State-level medical and absenteeism cost of asthma in the United States. J Asthma 2016; 54:357-370. [PMID: 27715355 DOI: 10.1080/02770903.2016.1218013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE For medically treated asthma, we estimated prevalence, medical and absenteeism costs, and projected medical costs from 2015 to 2020 for the entire population and separately for children in the 50 US states and District of Columbia (DC) using the most recently available data. METHODS We used multiple data sources, including the Medical Expenditure Panel Survey, U.S. Census Bureau, Kaiser Family Foundation, Medical Statistical Information System, and Current Population Survey. We used a two-part regression model to estimate annual medical costs of asthma and a negative binomial model to estimate annual school and work days missed due to asthma. RESULTS Per capita medical costs of asthma ranged from $1,860 (Mississippi) to $2,514 (Michigan). Total medical costs of asthma ranged from $60.7 million (Wyoming) to $3.4 billion (California). Medicaid costs ranged from $4.1 million (Wyoming) to $566.8 million (California), Medicare from $5.9 million (DC) to $446.6 million (California), and costs paid by private insurers ranged from $27.2 million (DC) to $1.4 billion (California). Total annual school and work days lost due to asthma ranged from 22.4 thousand (Wyoming) to 1.5 million days (California) and absenteeism costs ranged from $4.4 million (Wyoming) to $345 million (California). Projected increase in medical costs from 2015 to 2020 ranged from 9% (DC) to 34% (Arizona). CONCLUSION Medical and absenteeism costs of asthma represent a significant economic burden for states and these costs are expected to rise. Our study results emphasize the urgency for strategies to strengthen state level efforts to prevent and control asthma attacks.
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Affiliation(s)
- Tursynbek Nurmagambetov
- a Division of Environmental Hazards and Health Effects, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Olga Khavjou
- b RTI International, Research Triangle Park , NC , USA
| | - Louise Murphy
- c Division of Population Health, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Diane Orenstein
- d Division of Community Health, Centers for Disease Control and Prevention , Atlanta , GA , USA
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Buyantseva LV, Brooks J, Rossi M, Lehman E, Craig TJ. Risk factors associated with 30-day asthma readmissions. J Asthma 2016; 53:684-90. [PMID: 27031680 DOI: 10.3109/02770903.2016.1140773] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Assess factors that increase the odds of 30-day asthma readmissions to hospitals. METHODS Retrospective chart review between 1/1/2002 to 12/31/2012 of pediatric and adult patients with the primary diagnosis of asthma readmitted within 30 days after the index admission was performed. Patients were identified from billing database for asthma ICD 9 code (493.9). Inclusion criteria were: physician confirmed asthma diagnosis, one or more asthma admissions and accessible medical records. RESULTS A total of 95 patients with multiple asthma readmissions were included in the final analysis. Thirty-seven patients (39%) were readmitted for asthma within 30 days and 58 patients (61%) had readmission in a 30-365-day period. Demographic characteristics were not significantly different between groups. Bivariate analysis showed that factors associated with higher likelihood of readmissions were a higher frequency of previous admissions, ED visits, inpatient hospitalizations, ICU stays, intubations, chest X-rays, history of chronic sinusitis, gastroesophageal reflux disease, anxiety, and the use of tiotropium or a long-acting beta-agonist (LABA). Multivariable analysis confirmed that prior hospital admissions and a history of GERD are the strongest predictive factors for early asthma readmissions, yet a history of environmental allergies might be a protective factor (p = 0.053). CONCLUSIONS Non-allergic asthma patients with multiple prior admissions, ED visits and inpatient hospitalizations, on multiple medications with history of GERD, sinusitis, and anxiety are more likely to be readmitted within 30 days irrespective of other factors. Patients with these characteristics should be assessed for interventions in an effort to reduce early readmissions.
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Affiliation(s)
- Larisa V Buyantseva
- a Division of Pulmonary , Allergy and Critical Care, Penn State University, Hershey Medical Center , Hershey , PA , USA
| | - Joel Brooks
- b Heart of Lancaster Regional Medical Center , Lititz , PA , USA
| | - Melissa Rossi
- a Division of Pulmonary , Allergy and Critical Care, Penn State University, Hershey Medical Center , Hershey , PA , USA
| | - Erik Lehman
- c Division of Biostatistics in the Department of Public Health Sciences , Penn State University , Hershey , PA , USA
| | - Timothy J Craig
- a Division of Pulmonary , Allergy and Critical Care, Penn State University, Hershey Medical Center , Hershey , PA , USA
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Dürr S, Hersberger KE, Zeller A, Scheuzger J, Miedinger D, Gregoriano C, Leuppi JD, Steurer-Stey C. The integrated care of asthma in Switzerland (INCAS)-study: Patients' perspective of received asthma care and their interest in asthma education. J Asthma 2016; 53:955-63. [PMID: 27115047 DOI: 10.3109/02770903.2016.1170140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE For successful long-term asthma care, self-management education is a cornerstone. Little is known about associations between patients' interest in education, asthma control and care delivery. We compared patients' characteristics, asthma control and patients' perspective about asthma care in subjects with and without interest in asthma education. Moreover, we assessed reasons, why patients denied participating in asthma education. METHODS Baseline data of 223 patients with asthma (age 43 ± 12 years, 38% male, 58% non-smokers, 13% current smokers), who participated in a multicentre longitudinal controlled study, are reported. At baseline, patients completed the Asthma Control Test (ACT), the Patient Assessment Chronic Illness Care questionnaire (PACIC 5A) and stated their interest in an asthma education programme. RESULTS Overall, 34% of all participants showed uncontrolled asthma. One hundred and twenty-five (56%) patients were interested in education. Compared to patients without interest, they were characterised by male gender (p = 0.013), worse asthma control (p < 0.001), and perception of lower quality of chronic asthma care delivery, in particular lower self-management support (p < 0.001). Main reasons for rejecting asthma education were having sufficient asthma knowledge, having only mild asthma, receiving adequate medical support and lack of time. CONCLUSIONS More than half of the patients were interested in asthma education. Interest was associated with worse asthma control and lower receipt of care according to the Chronic Care Model. Considering these aspects, this approach may help to improve care quality and allow targeting interventions to those patients who are interested in becoming active participants in their care and who might benefit most.
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Affiliation(s)
- Selina Dürr
- a Medical University Clinic, Cantonal Hospital Baselland , Liestal , Switzerland.,b Faculty of Medicine, University of Zurich , Switzerland
| | - Kurt E Hersberger
- c Department of Pharmaceutical Sciences , University of Basel , Switzerland
| | - Andreas Zeller
- a Medical University Clinic, Cantonal Hospital Baselland , Liestal , Switzerland.,d Center for Primary Health Care, University of Basel , Switzerland
| | - Jonas Scheuzger
- a Medical University Clinic, Cantonal Hospital Baselland , Liestal , Switzerland
| | - David Miedinger
- a Medical University Clinic, Cantonal Hospital Baselland , Liestal , Switzerland.,e Faculty of Medicine, University of Basel , Switzerland
| | - Claudia Gregoriano
- a Medical University Clinic, Cantonal Hospital Baselland , Liestal , Switzerland
| | - Jörg D Leuppi
- a Medical University Clinic, Cantonal Hospital Baselland , Liestal , Switzerland.,e Faculty of Medicine, University of Basel , Switzerland
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Plaza V, Peiró M, Torrejón M, Fletcher M, López-Viña A, Ignacio JM, Quintano JA, Bardagí S, Gich I. A repeated short educational intervention improves asthma control and quality of life. Eur Respir J 2015; 46:1298-307. [PMID: 26405291 DOI: 10.1183/13993003.00458-2015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/09/2015] [Indexed: 12/11/2022]
Abstract
We assessed the effectiveness of an asthma educational programme based on a repeated short intervention (AEP-RSI) to improve asthma control (symptom control and future risk) and quality of life. A total of 230 adults with mild-to-moderate persistent uncontrolled asthma participated in a 1-year cluster randomised controlled multicentre study. The AEP-RSI was given in four face-to-face sessions at 3-month intervals, and included administration of a written personalised action plan and training on inhaler technique. Centres were randomised to the AEP-RSI (intervention) group or usual clinical practice group. Specialised centres using a standard educational programme were the gold standard group. A significant improvement in the Asthma Control Test score was observed in all three groups (p<0.001), but improvements were higher in the intervention and gold standard groups than in the usual clinical practice group (p=0.042), which also showed fewer exacerbations (mean±sd; 1.20±2.02 and 0.56±1.5 versus 2.04±2.72, respectively) and greater increases in the Mini Asthma Quality of Life Questionnaire scores (0.95±1.04 and 0.89±0.84 versus 0.52±0.97, respectively). The AEP-RSI was effective in improving asthma symptom control, future risk and quality of life.
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Affiliation(s)
- Vicente Plaza
- Dept of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Meritxell Peiró
- Dept of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Montserrat Torrejón
- Dept of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Antolín López-Viña
- Pulmonology Dept, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | | | - Ignasi Gich
- Dept of Epidemiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autónoma de Barcelona, Barcelona, Spain A full list of the PROMETHEUS Study Group investigators and participating centres can be found in the Acknowledgements section
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Basyouni MH, BinDhim NF, Saini B, Williams KA. Online Health Information Needs for Patients with Asthma in Saudi Arabia. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2015. [DOI: 10.1080/15398285.2014.982050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Panagioti M, Richardson G, Murray E, Rogers A, Kennedy A, Newman S, Small N, Bower P. Reducing Care Utilisation through Self-management Interventions (RECURSIVE): a systematic review and meta-analysis. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02540] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BackgroundA critical part of future service delivery will involve improving the degree to which people become engaged in ‘self-management’. Providing better support for self-management has the potential to make a significant contribution to NHS efficiency, as well as providing benefits in patient health and quality of care.ObjectiveTo determine which models of self-management support are associated with significant reductions in health services utilisation (including hospital use) without compromising outcomes, among patients with long-term conditions.Data sourcesCochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, EconLit (the American Economic Association’s electronic bibliography), EMBASE, Health Economics Evaluations Database, MEDLINE (the US National Library of Medicine’s database), MEDLINE In-Process & Other Non-Indexed Citations, NHS Economic Evaluation Database (NHS EED) and PsycINFO (the behavioural science and mental health database), as well as the reference lists of published reviews of self-management support.MethodsWe included patients with long-term conditions in all health-care settings and self-management support interventions with varying levels of additional professional support and input from multidisciplinary teams. Main outcome measures were quantitative measures of service utilisation (including hospital use) and quality of life (QoL). We presented the results for each condition group using a permutation plot, plotting the effect of interventions on utilisation and outcomes simultaneously and placing them in quadrants of the cost-effectiveness plane depending on the pattern of outcomes. We also conducted conventional meta-analyses of outcomes.ResultsWe found 184 studies that met the inclusion criteria and provided data for analysis. The most common categories of long-term conditions included in the studies were cardiovascular (29%), respiratory (24%) and mental health (16%). Of the interventions, 5% were categorised as ‘pure self-management’ (without additional professional support), 20% as ‘supported self-management’ (< 2 hours’ support), 47% as ‘intensive self-management’ (> 2 hours’ support) and 28% as ‘case management’ (> 2 hours’ support including input from a multidisciplinary team). We analysed data across categories of long-term conditions and also analysed comparing self-management support (pure, supported, intense) with case management. Only a minority of self-management support studies reported reductions in health-care utilisation in association with decrements in health. Self-management support was associated with small but significant improvements in QoL. Evidence for significant reductions in utilisation following self-management support interventions were strongest for interventions in respiratory and cardiovascular disorders. Caution should be exercised in the interpretation of the results, as we found evidence that studies at higher risk of bias were more likely to report benefits on some outcomes. Data on hospital use outcomes were also consistent with the possibility of small-study bias.LimitationsSelf-management support is a complex area in which to undertake literature searches. Our analyses were limited by poor reporting of outcomes in the included studies, especially concerning health-care utilisation and costs.ConclusionsVery few self-management support interventions achieve reductions in utilisation while compromising patient outcomes. Evidence for significant reductions in utilisation were strongest for respiratory disorders and cardiac disorders. Research priorities relate to better reporting of the content of self-management support, exploration of the impact of multimorbidity and assessment of factors influencing the wider implementation of self-management support.Study registrationThis study is registered as PROSPERO CRD42012002694.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Anne Rogers
- Health Sciences, University of Southampton, Southampton, UK
| | - Anne Kennedy
- Health Sciences, University of Southampton, Southampton, UK
| | - Stanton Newman
- School of Health Sciences, City University London, London, UK
| | - Nicola Small
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Pai S, Mancuso CA, Loganathan R, Boutin-Foster C, Basir R, Kanna B. Characteristics of asthmatic patients with and without repeat emergency department visits at an inner city hospital. J Asthma 2014; 51:627-32. [PMID: 24588683 PMCID: PMC4138125 DOI: 10.3109/02770903.2014.899604] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Abstract Objective: The objective of this study was to document the frequency and clinical characteristics associated with repeat emergency department (ED) visits for asthma in an inner city population with a high burden of asthma. METHODS During an ED visit for asthma in an inner city hospital ('index visit'), patients completed a valid survey addressing disease and behavioral factors. Hospital records were reviewed for information about ED visits and hospitalizations for asthma during the 12 months before and the 90 days after the index visit. RESULTS One hundred and ninety-two patients were enrolled; the mean age was 42 years, 69% were women, 36% were black, 54% were Latino, 69% had Medicaid, and 17% were uninsured. 100 patients (52%) were treated and released from the ED, 88 patients (46%) were hospitalized, and 4 patients (2%) left against medical advice. During the subsequent 90 days, 64 patients (33%) had at least one repeat ED visit for asthma and 27 (14%) were hospitalized for asthma. In a multivariate model, more past ED visits (OR 1.7, 95% CI 1.4, 2.1; p < 0.0001) and male gender (OR 2.5, 95% CI 1.2, 5.4; p = 0.02) remained associated with having a repeat ED visit. Most patients had the first repeat ED visit within 30 days and 18 returned within only 7 days. Among all patients with a repeat visit, those who were not hospitalized for the index visit were more likely to have a repeat visit within 7 days (37%) compared to those who were hospitalized (17%) (p = 0.05 in multivariate analysis). CONCLUSIONS Repeat ED visits were prevalent among inner city asthma patients and most occurred shortly after the index visit. The strongest predictors of repeat visits were male gender and more ED visits in the 12 months before the index visit.
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Affiliation(s)
- Sucheta Pai
- Department of Internal Medicine, Weill Cornell Medical College , New York, NY , USA
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Federman AD, Wolf M, Sofianou A, Wilson EAH, Martynenko M, Halm EA, Leventhal H, Wisnivesky JP. The association of health literacy with illness and medication beliefs among older adults with asthma. PATIENT EDUCATION AND COUNSELING 2013; 92:273-8. [PMID: 23523196 PMCID: PMC3720706 DOI: 10.1016/j.pec.2013.02.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/05/2013] [Accepted: 02/27/2013] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Suboptimal health literacy (HL) and asthma beliefs are associated with poor asthma self-management and outcomes. We tested the hypothesis that low HL is associated with inaccurate beliefs. METHODS Asthmatics ≥60 were recruited from hospital and community practices in New York, NY and Chicago, IL (n=420). HL was measured with the Short Test of Functional Health Literacy in Adults; validated instruments derived from the self regulation model were used to assess beliefs. The association of beliefs with HL was evaluated with multivariate models. RESULTS Thirty-six percent of patients had low HL; 54% believed they only have asthma when symptoms are present, 29% believed they will not always have asthma and 20% believed that their doctor can cure asthma. HL was associated with beliefs of not having asthma all the time and that asthma can be cured (OR: 1.84, 95% CI: 1.2-2.82; OR: 2.22, 95% CI: 1.29-3.82, respectively). Patients with low HL were also more likely to be concerned about medication use (β=0.92, p=.05), despite recognizing their necessity (β=-1.36, p=.01). CONCLUSIONS Older asthmatics with low HL endorse erroneous asthma beliefs. PRACTICE IMPLICATIONS Health communications for improving self-management behaviors in asthma should employ both health literacy-appropriate strategies and messages to counter illness-related misconceptions.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Mancuso CA, Choi TN, Westermann H, Wenderoth S, Wells MT, Charlson ME. Improvement in asthma quality of life in patients enrolled in a prospective study to increase lifestyle physical activity. J Asthma 2012; 50:103-7. [PMID: 23173979 DOI: 10.3109/02770903.2012.743150] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma patients know the benefits of exercise but often avoid physical activity because they are concerned that it will exacerbate asthma. The objective of this analysis was to assess longitudinal asthma status in 256 primary care patients in New York City enrolled in a trial to increase lifestyle physical activity. METHODS Patients were randomized to two protocols to increase physical activity during a period of 12 months. At enrollment, patients completed the Asthma Quality of Life Questionnaire (AQLQ) and the Asthma Control Questionnaire (ACQ) and received asthma self-management instruction through an evaluative test and workbook. Exercise and self-management were reinforced every 2 months. The AQLQ was repeated every 4 months and the ACQ was repeated at 12 months. RESULTS The mean age was 43 years and 75% were women. At 12 months there were clinically important increases in physical activity with no differences between groups; thus, data were pooled for asthma analyses. The enrollment AQLQ score was 5.0 ± 1.3 and increased to 5.9 ± 1.1 corresponding to a clinically important difference. Correlations between AQLQ and physical activity were approximately 0.35 (p < .0001) at each time point. In a mixed effects model, the variables associated with improvement in AQLQ scores over time were male sex, less severe asthma, not taking asthma maintenance medications, fewer depressive symptoms, and increased physical activity (all variables, p < .03). According to the ACQ, asthma was well controlled in 38% at enrollment and in 60% at 12 months (p < .0001). CONCLUSION With attention to self-management, increased physical activity did not compromise asthma control and was associated with improved asthma.
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Peterson MGE, Gaeta TJ, Birkhahn RH, Fernández JL, Mancuso CA. History of symptom triggers in patients presenting to the emergency department for asthma. J Asthma 2012; 49:629-36. [PMID: 22742414 DOI: 10.3109/02770903.2012.690480] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Understanding triggers is important for managing asthma particularly for patients who seek emergency department (ED) care for exacerbations. The objectives of this analysis were to delineate self-reported triggers in ED patients and to assess associations between triggers and asthma knowledge, severity, and quality of life. METHODS At the time of an ED visit, 296 patients were asked what were their usual asthma triggers based on a checklist of 25 potential items, and what they thought specifically precipitated their current ED visit. Using standardized scales, patients also were asked about asthma knowledge, severity, and quality of life. RESULTS The mean age was 44 years and 72% were women. Patients cited a mean of 12 triggers; most patients had diverse triggers spanning respiratory infections, environmental irritants, emotions, allergens, weather, and exercise. Patients with more triggers were more likely to be women (odds ratio (OR) = 2.0, confidence interval (CI) = 1.3, 3.2, p = .002), obese (OR = 1.7, CI = 1.1, 2.5, p = .01), and to not have a smoking history (OR = 1.9, CI = 1.3, 2.9, p = .001). There were no associations between number of triggers and current age, age at diagnosis, education, socioeconomic status, or race/ethnicity. Patients who cited more triggers had more frequent flares (OR = 1.1, CI = 1.1, 1.2, p < .0001), worse quality of life scores (OR 1.6, CI = 1.1, 2.4, p = .02), and were more likely to have been previously hospitalized for asthma (OR = 1.9, CI = 1.3, 2.9, p = .003) and to have previously required oral corticosteroids (OR = 2.9, CI = 1.6, 5.1, p = .003). There was little clustering of specific triggers according to the variables we considered except for more frequent animal allergy in patients diagnosed at a younger age (OR = 2.8, CI = 1.7, 4.5, p < .0001) and worse quality of life in patients citing emotional stress as a trigger (OR = 2.5, CI = 1.5, 4.0, p = .0002). Patients attributed their current ED visit to multiple precipitants, particularly respiratory infections and weather, and these were concordant with what they reported were known triggers. CONCLUSIONS Patients presenting to the ED for asthma reported multiple triggers spanning diverse classes of precipitants and having more triggers was associated with worse clinical status. ED patients should be instructed that although it may not be possible to eliminate all triggers, mitigating even some triggers can be helpful.
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Affiliation(s)
- Margaret G E Peterson
- Research Division, Hospital for Special Surgery Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA
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Mancuso CA, Choi TN, Westermann H, Wenderoth S, Hollenberg JP, Wells MT, Isen AM, Jobe JB, Allegrante JP, Charlson ME. Increasing physical activity in patients with asthma through positive affect and self-affirmation: a randomized trial. ARCHIVES OF INTERNAL MEDICINE 2012; 172:337-43. [PMID: 22269593 PMCID: PMC3640830 DOI: 10.1001/archinternmed.2011.1316] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Patients with asthma engage in less physical activity than peers without asthma. Protocols are needed to prudently increase physical activity in asthma patients. We evaluated whether an educational intervention enhanced with positive-affect induction and self-affirmation was more effective than the educational protocol alone in increasing physical activity in asthma patients. METHODS We conducted a randomized trial in New York City from September 28, 2004, through July 5, 2007; of 258 asthma patients, 252 completed the trial. At enrollment, control subjects completed a survey measuring energy expenditure, made a contract to increase physical activity, received a pedometer and an asthma workbook, and then underwent bimonthly follow-up telephone calls. Intervention patients received this protocol plus small gifts and instructions in fostering positive affect and self-affirmation. The main outcome was the within-patient change in energy expenditure in kilocalories per week from enrollment to 12 months with an intent-to-treat analysis. RESULTS Mean (SD) energy expenditure at enrollment was 1767 (1686) kcal/wk among controls and 1860 (1633) kcal/wk among intervention patients (P = .65) and increased by 415 (95% CI, 76-754; P = .02) and 398 (95% CI, 145-652; P = .002) kcal/wk, respectively, with no difference between groups (P = .94). For both groups, energy expenditure was sustained through 12 months. No adverse events were attributed to the trial. In multivariate analysis, increased energy expenditure was associated with less social support, decreased depressive symptoms, more follow-up calls, use of the pedometer, fulfillment of the contract, and the intervention among patients who required urgent asthma care (all P < .10, 2-sided test). CONCLUSIONS A multiple-component protocol was effective in increasing physical activity in asthma patients, but an intervention to increase positive affect and self-affirmation was not effective within this protocol. The intervention may have had some benefit, however, in the subgroup of patients who required urgent asthma care during the trial. Trial Registration clinicaltrials.gov Identifier: NCT00195117.
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Affiliation(s)
| | | | | | | | | | | | - Alice M. Isen
- Department of Psychology and Johnson Graduate School of Management, Cornell University
| | | | - John P. Allegrante
- Teachers College and Mailman School of Public Health, Columbia University
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Mancuso CA, Peterson MGE, Gaeta TJ, Fernández JL, Birkhahn RH. Time to seeking emergency department care for asthma: self-management, clinical features at presentation, and hospitalization. J Asthma 2012; 49:275-81. [PMID: 22356431 DOI: 10.3109/02770903.2012.661011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Understanding the events preceding emergency department (ED) asthma visits can guide patient education regarding managing exacerbations and seeking timely care. The objectives of this analysis were to assess time to seeking ED care, self-management of asthma exacerbations, and clinical status on presentation. METHODS A total of 296 patients was grouped according to time to seeking ED care: ≤1 day (22%), 2-5 days (44%), and >5 days (34%) and was compared for clinical and psychosocial characteristics. Asthma severity at presentation was obtained from patient report with the Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ) and from physicians' ratings using decision to hospitalize as an indicator of worse status. RESULTS. Mean age was 44 years, 72% were women, 10% had been in the ED in the prior week, and 28% came to the ED by ambulance. Patients who waited longer were more likely to be older, have more depressive symptoms, and have been in the ED in the prior week. They also were more likely to have taken more medications, but they were not more likely to have visited or consulted their outpatient physicians. Patients who waited longer reported worse ACQ (p < .0001) and AQLQ (p = .0002) scores and were more likely to be hospitalized for the current exacerbation (odds ratio 1.9, 95% CI 1.1, 3.2, p = .03). CONCLUSIONS Patients who waited longer to come to the ED had worse asthma on presentation, had more functional limitations, and were more likely to be hospitalized. The ability to gauge severity of exacerbations and the use of the ED in a timely manner are important but often overlooked are self-management skills that patients should be taught.
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Affiliation(s)
- Carol A Mancuso
- Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY 10021, USA.
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