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Bickel S, Cohen RT, Needleman JP, Volerman A. Appropriate inhaler use in children with asthma: barriers and opportunities through the lens of the socio-ecological model. J Asthma 2023; 60:1269-1279. [PMID: 36420559 PMCID: PMC10192155 DOI: 10.1080/02770903.2022.2152352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022]
Abstract
Objective: Proper use of inhaled medications is essential for management of asthma, as inhaled therapies are recommended as first-line for both prevention and treatment of asthma symptoms. Optimizing adherence requires identifying and understanding multiple layers of systemic complexity to obtaining and using these therapies and offering specific solutions to address these barriers. Bronfenbrenner's socio-ecological model provides a framework for examining multilevel systems - both internal and external - that contribute to the management of childhood asthma. The four levels in this model consist of factors related to the individual, interpersonal relationships, organizational entities, and societal structures and rules. This narrative review identifies influences and factors related to asthma inhaler adherence by each level and offers evidence-based solutions to each obstacle.Data Sources: We conducted PubMed searches to identify relevant articles for barriers and solutions impacting asthma control at each level of the socio-ecological model.Study Selection: Common barriers to asthma control at each model level were identified. Pertinent studies for each barrier were identified and reviewed by the writing group for inclusion into the narrative review.Results: For each level of the socio-ecological model, three primary issues were identified based on the literature review. Approaches for addressing each issue in an evidence-based, systematic fashion are presented.Conclusion: Understanding the obstacles and potential interventions to achieve proper use of inhaled medications is a critical step necessary to develop and implement systematic solutions aimed at improving asthma control and morbidity for the more than 6 million affected children in the United States.
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Affiliation(s)
- Scott Bickel
- Division of Pediatric Pulmonology, Allergy & Immunology, Norton Children’s and University of Louisville School of Medicine, Louisville, KY, USA
| | - Robyn T. Cohen
- Division of Pediatric Pulmonary and Allergy, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Joshua P. Needleman
- Division of Pediatric Pulmonology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Anna Volerman
- Department of Medicine and Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Shukla PJ, Sandel P, Phull G, Rethy JA. Development and Utilization of a Diagnostic Support Tool for Asthma within the Electronic Medical Record. J Med Syst 2022; 46:65. [PMID: 36040523 DOI: 10.1007/s10916-022-01858-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/26/2022] [Indexed: 12/01/2022]
Abstract
Asthma in childhood is a common and costly chronic disease. Quality asthma care can lead to better control of asthma thus decreasing use of health services. The gold standard for pediatric asthma diagnosis and management is the National Heart, Lung and Blood Institute (NHLBI) guidelines for Diagnosis and Management of Asthma which center on precisely establishing the severity of asthma, as this precise classification delineates appropriate therapy. However, navigating these guidelines is a challenge for primary care providers that creates a barrier to providing quality care. We aim to improve precision in asthma severity classification in the community healthcare setting through the development of an electronic asthma decision support tool (eADST) incorporating NHLBI guidelines embedded within the electronic health record system. We developed an algorithm for the eADST to guide the health care provider to the appropriate classification and subsequent therapy. We engaged our health system's electronic health record informatics team and together developed and revised the tool. We launched the tool in three academic community clinics and measured precision in asthma classification in the twelve months prior to the availability of the tool and the twelve months following the launch. We found a significant improvement in precision of asthma severity classification following the launch, a necessary first step in improvement of asthma care. The next step will be to evaluate the impact of the tool on asthma outcomes.
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Affiliation(s)
- Prateek J Shukla
- Department of Pediatrics, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Piper Sandel
- Division of Community Pediatrics, MedStar Georgetown University Hospital, 4200 Wisconsin Ave NW 4th Floor, Washington, DC, 20016, USA
| | - Gurpreet Phull
- Division of Pulmonary and Sleep Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Janine A Rethy
- Division of Community Pediatrics, MedStar Georgetown University Hospital, 4200 Wisconsin Ave NW 4th Floor, Washington, DC, 20016, USA.
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Wu AC, Greenberger PA. Asthma: Overdiagnosed, Underdiagnosed, and Ineffectively Treated. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:801-802. [PMID: 29747983 DOI: 10.1016/j.jaip.2018.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Ann Chen Wu
- Center for Healthcare Research in Pediatrics (CHeRP), Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Paul A Greenberger
- Center for Healthcare Research in Pediatrics (CHeRP), Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Sumino K, Bacharier LB, Taylor J, Chadwick-Mansker K, Curtis V, Nash A, Jackson-Triggs S, Moen J, Schechtman KB, Garbutt J, Castro M. A Pragmatic Trial of Symptom-Based Inhaled Corticosteroid Use in African-American Children with Mild Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:176-185.e2. [PMID: 31371165 DOI: 10.1016/j.jaip.2019.06.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Symptom-based adjustment (SBA) of inhaled corticosteroids may be an alternative patient-centered approach in which day-to-day inhaled corticosteroid use is adjusted by symptoms and short-acting β-agonist need. OBJECTIVE To evaluate the effectiveness of SBA in the primary care setting. METHODS We conducted a randomized, open-label, pragmatic equivalence trial in African-American children (6-17 years old) with mild asthma managed by 12 primary care providers (PCPs). A total of 206 participants were randomized to SBA (as-needed beclomethasone 80 μg with rescue short-acting β-agonist) or provider-based guideline-directed adjustment (PBA): maintenance beclomethasone 80 μg/d (6-11 years old), 160 μg/d (12-17 years old), with subsequent guideline-based dose adjustment by PCPs. PCPs implemented both treatment assignments, with outcomes measured by blinded staff. All participants received symptom recognition and albuterol use education from peer educators. Primary outcome was change in asthma control (measured by Asthma Control Test [ACT]/childhood ACT [cACT]) over 12 months. RESULTS Participants had adequately controlled asthma (mean ACT or cACT score = 21.6 ± 2.8) at baseline. After 1 year, there was no significant between-group difference in change in ACT scores (SBA - PBA): ACT: -0.88 (95% CI, -2.19 to 0.42), cACT: -0.73 (-2.09 to 0.62), or combined ACT and cACT (P = .10), and was within the predefined statistical clinical equivalence. The proportion with an exacerbation and measures of lung function were similar between groups. Compared with PBA, SBA led to less beclomethasone use (SBA: 526 μg/mo [95% CI, 412-639 μg] vs PBA: 1961 μg/mo [95% CI, 1681-2241]; P < .0001). More parents in the SBA arm felt they were managing their child's asthma. CONCLUSIONS SBA in African-American children with mild asthma was similar to PBA in asthma control and events when implemented by PCPs with lower inhaled corticosteroid exposure.
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Affiliation(s)
- Kaharu Sumino
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Mo.
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Mo; Division of Allergy, Immunology and Pulmonary Medicine, Washington University School of Medicine, Saint Louis, Mo
| | - Juanita Taylor
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Mo
| | - Kelley Chadwick-Mansker
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Mo
| | - Vanessa Curtis
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Mo
| | - Alison Nash
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Mo
| | - Shawni Jackson-Triggs
- Department of Medicine, Division of Biostatistics, Washington University School of Medicine, Saint Louis, Mo
| | - Joseph Moen
- Department of Medicine, Division of Biostatistics, Washington University School of Medicine, Saint Louis, Mo
| | - Kenneth B Schechtman
- Department of Medicine, Division of Biostatistics, Washington University School of Medicine, Saint Louis, Mo
| | - Jane Garbutt
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Mo; Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, Saint Louis, Mo
| | - Mario Castro
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Mo
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Herman E, Beavers S, Hamlin B, Thaker K. Is It Time for a Patient-Centered Quality Measure of Asthma Control? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1771-1777. [PMID: 30954466 DOI: 10.1016/j.jaip.2019.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 02/03/2019] [Accepted: 02/17/2019] [Indexed: 11/28/2022]
Abstract
Quality measures play a prominent role in the US health care system. They are used to monitor and report performance across health plans, providers, and health systems and are a foundational element of value-based payment. Measuring the quality of asthma care has been challenging because of a lack of reliable data to assess clinical processes and track patient-specific outcomes. Existing asthma Healthcare Effectiveness Data and Information Set measures rely on administrative claims-derived data on dispensed medications. These are proxy measures of appropriate prescribing but are not reflective of comprehensive asthma care. The increase in the volume and specificity of longitudinal clinical data in electronic health records, movement toward electronic quality measures, and advances in electronic clinical data systems enable the development of more meaningful measures. A patient-reported measure of asthma control would incorporate key clinical indicators such as a validated age- and culturally appropriate test, and would reflect the combined outcome of medical management, self-management education, reduction of environmental exposures, and appropriate support services. Although there is a current quality measure that includes a test of asthma control (the Optimal Asthma Control Measure), work is needed to address questions about usability, patient literacy, and the influence of setting on self-reported scores. Comprehensive reliability and validity testing of both clinical data and stratification across risk groups will be needed to determine whether a measure based on standardized assessments of asthma control indeed promote improved clinical outcomes.
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Affiliation(s)
- Elizabeth Herman
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga.
| | - Suzanne Beavers
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Ben Hamlin
- National Committee for Quality Assurance, Washington, DC
| | - Kaytna Thaker
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga
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Treatment adherence and level of control in moderate persistent asthma in children and adolescents treated with fluticasone and salmeterol. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Jentzsch NS, Silva GCG, Mendes GMS, Brand PLP, Camargos P. Treatment adherence and level of control in moderate persistent asthma in children and adolescents treated with fluticasone and salmeterol. J Pediatr (Rio J) 2019; 95:69-75. [PMID: 29274305 DOI: 10.1016/j.jped.2017.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 10/05/2017] [Accepted: 10/18/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE There is a scarcity of studies that assessed the association between adherence to combination therapy and asthma control in pediatric patients. The authors investigated the association between adherence to fluticasone propionate/salmeterol xinafoate combination-metered aerosol and the level of asthma control in children. METHODS This was a prospective observational study of 84 patients aged 5-16 years with moderate persistent asthma, who remained uncontrolled despite the use of 1000μg/day of inhaled nonextrafine-hydrofluoric alkane-beclomethasone dipropionate in the three months prior to study enrollment. Participants were prescribed two daily doses of FP (125μg)/salmeterol xinafoate (25μg) combination by metered aerosol/spacer for six months. Adherence rates were assessed using the device's dose counter after the 2nd, 4th, and 6th months of follow up. Asthma control was assessed using a simplified Global Initiative for Asthma 2014 Report classification. RESULTS Mean adherence rates after the second, fourth, and sixth months were 87.8%, 74.9%, and 62.1% respectively, for controlled asthma, and 71.7%, 56.0%, and 47.6% respectively, for uncontrolled asthma (all p-values≤0.03). The proportion of children achieving asthma control increased to 42.9%, 67.9% and 89.3% after the 2nd, 4th and 6th months of follow-up, respectively (p≤0.001). CONCLUSION Adherence rates between 87.8% in the 2nd month and 62.1% in the 6th month were strong determinants of asthma control.
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Affiliation(s)
- Nulma S Jentzsch
- Faculdade de Ciências Médicas de Minas Gerais, Hospital Universitário Ciências Médicas, Belo Horizonte, MG, Brazil.
| | - Gabriela C G Silva
- Faculdade de Ciências Médicas de Minas Gerais, Hospital Universitário Ciências Médicas, Belo Horizonte, MG, Brazil
| | - Guilherme M S Mendes
- Faculdade de Ciências Médicas de Minas Gerais, Hospital Universitário Ciências Médicas, Belo Horizonte, MG, Brazil
| | - Paul L P Brand
- Isala Hospital, Princess Amalia Children's Centre, Zwolle, The Netherlands; University Medical Centre and University of Groningen, UMCG Postgraduate School of Medicine, Groningen, The Netherlands
| | - Paulo Camargos
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Unidade de Pneumologia Pediátrica, Belo Horizonte, MG, Brazil
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8
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Mosnaim G, Liu AH, Simone LC, Shalowitz M, Schafer EH, Bandi S, Codispoti CD, Mateka JJL, Greene L, Sapir T. Parent-physician perceptions of shared decision-making and care coordination for children with asthma. Ann Allergy Asthma Immunol 2018; 121:633-634. [PMID: 30134182 DOI: 10.1016/j.anai.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Andrew H Liu
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Ewa H Schafer
- NorthShore University Health System, Evanston, Illinois
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Welch M, Ludden T, Mottus K, Bray P, Hendrickson L, Rees J, Halladay J, Tapp H. Patient and provider perspectives on uptake of a shared decision making intervention for asthma in primary care practices. J Asthma 2018; 56:562-572. [PMID: 29927661 DOI: 10.1080/02770903.2018.1471703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Poor outcomes and health disparities related to asthma result in part from difficulty disseminating new evidence such as shared decision making (SDM) into clinical practice. As part of a three-arm cluster randomized dissemination study, evaluation of the impact of different dissemination methods was studied. Here we evaluate themes from patient and provider focus groups to assess the impact of a facilitated, traditional dissemination approach, or no intervention, on patient and provider perspectives of asthma care. METHODS Using semi-structured questions, twenty-four pre- and post-intervention focus groups with patients and providers took place across primary care practices. Discussions were held in all three arms both before and after the time of intervention rollout. Audio recordings were transcribed and analyzed for themes. RESULTS Across all sites patients and providers discussed themes of communication, asthma self-management, barriers, education, and patient awareness. After the intervention, compared to traditional sites, facilitated practices were more likely to discuss themes related to SDM, such as patient-centered communication, patient-provider negotiation on treatment plan, planning, goal-setting, and solutions to barriers. CONCLUSIONS Emergent themes allowed for further understanding of how the SDM implementation was perceived at the patient and provider level. The facilitated implementation was associated with higher adoption of the SDM intervention. These themes and supporting quotes add to knowledge of best practices associated with implementing an evidence-based SDM intervention for asthma into primary care and will inform researchers, practices, and providers as they work to improve adoption of evidence-based interventions into practice.
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Affiliation(s)
- Madelyn Welch
- a Atrium Health, Department of Family Medicine Research , Charlotte , NC , USA
| | - Thomas Ludden
- a Atrium Health, Department of Family Medicine Research , Charlotte , NC , USA
| | - Kathleen Mottus
- b University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Paul Bray
- c Vidant Medical Group , Greenville , NC , USA
| | | | - Jennifer Rees
- b University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | | | - Hazel Tapp
- a Atrium Health, Department of Family Medicine Research , Charlotte , NC , USA
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Dy T, Lewis EM, Murugan V, Gehlert S, Taylor J, Garbutt J, Bacharier LB, Castro M, Sumino K. Caregiver and pediatric provider perspectives on symptom-based inhaled corticosteroid therapy in asthma. Respir Med 2018; 137:201-205. [PMID: 29605205 DOI: 10.1016/j.rmed.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 02/24/2018] [Accepted: 03/01/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Guidelines recommend that healthcare providers adjust the dose of inhaled corticosteroids (ICS) in asthma patients based on the degree of symptom severity and control. Symptom-based, intermittent ICS therapy (use of ICS together with short acting bronchodilators- symptom-based adjustment: SBA) has been demonstrated to be comparable to guideline-based management by providers in controlled clinical trials. We sought input from African American caregivers and pediatricians on the acceptability and barriers for this alternative management strategy. METHODS Focus group interviews of caregivers and individual interviews with community providers of African-American children ages 6-17 years with mild-moderate persistent asthma were conducted by trained facilitators to assess perceptions of how asthma affects children and their caregivers, and of SBA as a management strategy. Interview data were transcribed and analyzed using inductive thematic based coding. RESULTS Twenty-six parents participated in six focus groups. Fourteen pediatricians were interviewed. Caregivers reported facing financial burden and difficulty with tracking medications. Caregivers and pediatricians were favorable about SBA, citing its potential for decreased use of medications and cost and similarity to actual care provided. Some caregivers voiced concern that SBA would not be as effective as daily ICS. Caregivers suggested that education on symptom recognition and close communication between physician and patient would facilitate the implementation of SBA. CONCLUSIONS SBA was generally viewed favorably by caregivers and providers of African American children. However, concerns regarding effectiveness of SBA were voiced by both caregivers and providers. Patient education and provider-patient communication is important in implementing this alternative asthma management strategy.
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Affiliation(s)
- Tiffany Dy
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Ericka M Lewis
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Vithya Murugan
- Saint Louis University School of Public Health and Social Justice, Saint Louis, MO, USA
| | - Sarah Gehlert
- University of South Carolina College of Social Work, Columbia, SC, USA
| | - Juanita Taylor
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Jane Garbutt
- Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Mario Castro
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Kaharu Sumino
- Washington University School of Medicine, Saint Louis, MO, USA.
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11
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Allergy terminology: Toward a common language and shared understanding. J Allergy Clin Immunol 2018; 141:1133-1135. [DOI: 10.1016/j.jaci.2017.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/29/2017] [Accepted: 10/10/2017] [Indexed: 11/20/2022]
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12
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Arnold CM, Bixenstine PJ, Cheng TL, Tschudy MM. Concordance among children, caregivers, and clinicians on barriers to controller medication use. J Asthma 2018; 55:1352-1361. [PMID: 29420091 DOI: 10.1080/02770903.2018.1424188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE While much research has addressed asthma medication adherence, few have combined quantitative and qualitative data, and none has addressed the triad of child, caregiver, and clinician simultaneously. This study assessed, with mixed methods, barriers to medication adherence within this triad. METHODS We conducted interviews with publicly-insured children with asthma, their caregivers, and their primary-care clinicians. Children (7-17 years) had been prescribed daily inhaled corticosteroids and visited the ED for asthma (past year). Participants answered open-ended and survey questions, rating suggested barriers to medication use (never vs. ever a barrier). McNemar's tests compared report of barriers by each group (children, caregivers, clinicians), and assessed concordance within triads. RESULTS Fifty child-caregiver dyads participated (34 clinicians). Children (40% female; median age 10 years) had mostly non-Hispanic black (90%) caregivers with less than or equal to high-school education (68%). For barriers, children and clinicians were more likely than caregivers to report medications running out. Clinicians were also more likely to cite controllers being a "pain to take" (vs. children) and forgetfulness (vs. caregivers) (all p < .05). There was a lack of within-triad concordance regarding barriers to adherence, especially regarding medication running out, worrying about taking a daily medication, and medication being a pain to take. Qualitative data revealed themes of competing priorities, home routines, and division of responsibility as prominent contributors to medication adherence. CONCLUSIONS There was significant disagreement among children, caregivers, and clinicians regarding barriers to daily use of asthma medications. To tailor asthma management conversations, clinicians should understand family-specific barriers and child-caregiver disagreements.
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Affiliation(s)
- Carolyn M Arnold
- a Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Paul J Bixenstine
- b Departments of Pediatrics & Internal Medicine , University of California Los Angeles School of Medicine , Los Angeles , CA , USA
| | - Tina L Cheng
- a Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Megan M Tschudy
- a Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Trivedi M, Fung V, Kharbanda EO, Larkin EK, Butler MG, Horan K, Lieu TA, Wu AC. Racial disparities in family-provider interactions for pediatric asthma care. J Asthma 2017; 55:424-429. [PMID: 28708958 DOI: 10.1080/02770903.2017.1337790] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Black and Latino children experience significantly worse asthma morbidity than their white peers for multifactorial reasons. This study investigated differences in family-provider interactions for pediatric asthma, based on race/ethnicity. METHODS This was a cross-sectional study of parent surveys of asthmatic children within the Population-Based Effectiveness in Asthma and Lung Diseases Network. Our study population comprised 647 parents with survey response data. Data on self-reported race/ethnicity of the child were collected from parents of the children with asthma. Outcomes studied were responses to the questions about family-provider interactions in the previous 12 months: (1) number of visits with asthma provider; (2) number of times provider reviewed asthma medications with patient/family; (3) review of a written asthma treatment plan with provider; and (4) preferences about making asthma decisions. RESULTS In multivariate adjusted analyses controlling for asthma control and other co-morbidities, black children had fewer visits in the previous 12 months for asthma than white children: OR 0.63 (95% CI 0.40, 0.99). Additionally, black children were less likely to have a written asthma treatment plan given/reviewed by a provider than their white peers, OR 0.44 (95% CI 0.26, 0.75). There were no significant differences by race in preferences about asthma decision-making nor in the frequency of asthma medication review. CONCLUSION Black children with asthma have fewer visits with their providers and are less likely to have a written asthma treatment plan than white children. Asthma providers could focus on improving these specific family-provider interactions in minority children.
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Affiliation(s)
- Michelle Trivedi
- a Division of Pediatric Pulmonology and Quantitative Health Sciences , University of Massachusetts Medical School , Worcester , MA , USA
| | - Vicki Fung
- b Mongan Institute for Health Policy , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA
| | | | - Emma K Larkin
- d Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Melissa G Butler
- e Center for Clinical Outcomes & Research - Southeast , Kaiser Permanente Georgia , Atlanta , GA , USA.,f Roivant Sciences , Hamilton , Bermuda
| | - Kelly Horan
- g Center for Healthcare Research in Pediatrics, Department of Population Medicine , Harvard Pilgrim Health Care Institute and Harvard Medical School , Boston , MA , USA
| | - Tracy A Lieu
- h Division of Research , Kaiser Permanente Northern California , Oakland , CA , USA
| | - Ann Chen Wu
- g Center for Healthcare Research in Pediatrics, Department of Population Medicine , Harvard Pilgrim Health Care Institute and Harvard Medical School , Boston , MA , USA
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Schatz M, Sicherer SH, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice - 2016 Year in Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:218-236. [PMID: 28143692 DOI: 10.1016/j.jaip.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 01/19/2023]
Abstract
As editors, we concluded that it would be helpful to our readers to write a Year in Review article that highlights the Review, Original, and Clinical Communication articles published in 2016 in The Journal of Allergy and Clinical Immunology: In Practice. We summarized articles on the topics of asthma, rhinitis/rhinosinusitis, food allergy, anaphylaxis, drug allergy, urticarial/angioedema, eosinophilic disorders, and immunodeficiency. Within each topic, epidemiologic findings are presented, relevant aspects of prevention are described, and diagnostic and therapeutic advances are enumerated. Diagnostic tools described include history, skin tests, and in vitro tests. Treatments discussed include behavioral therapy, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We hope this review will help you, our readers, consolidate and use this extensive and practical knowledge for the benefit of your patients.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
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