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Huebschmann AG, Wagner NM, Gleason M, Brinton JT, Brtnikova M, Brewer SE, Begum A, Armstrong R, DeCamp LR, McFarlane A, DeKeyser H, Coleman H, Federico MJ, Szefler SJ, Cicutto LC. Reducing asthma attacks in disadvantaged school children with asthma: study protocol for a type 2 hybrid implementation-effectiveness trial (Better Asthma Control for Kids, BACK). Implement Sci 2024; 19:60. [PMID: 39148094 PMCID: PMC11325631 DOI: 10.1186/s13012-024-01387-3] [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: 06/21/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Asthma is a leading cause of children's hospitalizations, emergency department visits, and missed school days. Our school-based asthma intervention has reduced asthma exacerbations for children experiencing health disparities in the Denver Metropolitan Area, due partly to addressing care coordination for asthma and social determinants of health (SDOH), such as access to healthcare and medications. Limited dissemination of school-based asthma programs has occurred in other metropolitan and rural areas of Colorado. We formed and engaged community advisory boards in socioeconomically diverse regions of Colorado to develop two implementation strategy packages for delivering our school-based asthma intervention - now termed "Better Asthma Control for Kids (BACK)" - with tailoring to regional priorities, needs and resources. METHODS In this proposed type 2 hybrid implementation-effectiveness trial, where the primary goal is equitable reach to families to reduce asthma disparities, we will compare two different packages of implementation strategies to deliver BACK across four Colorado regions. The two implementation packages to be compared are: 1) standard set of implementation strategies including Tailor and Adapt to context, Facilitation and Training termed, BACK-Standard (BACK-S); 2) BACK-S plus an enhanced implementation strategy, that incorporates network weaving with community partners and consumer engagement with school families, termed BACK-Enhanced (BACK-E). Our evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, including its Pragmatic Robust Implementation Sustainability Model (PRISM) determinants of implementation outcomes. Our central hypothesis is that our BACK-E implementation strategy will have significantly greater reach to eligible children/families than BACK-S (primary outcome) and that both BACK-E and BACK-S groups will have significantly reduced asthma exacerbation rates ("attacks") and improved asthma control as compared to usual care. DISCUSSION We expect both the BACK-S and BACK-E strategy packages will accelerate dissemination of our BACK program across the state - the comparative impact of BACK-S vs. BACK-E on reach and other RE-AIM outcomes may inform strategy selection for scaling BACK and other effective school-based programs to address chronic illness disparities. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT06003569, registered on August 22, 2023, https://classic. CLINICALTRIALS gov/ct2/show/NCT06003569 .
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Affiliation(s)
- Amy G Huebschmann
- Anschutz Medical Campus Department of Medicine, Division of General Internal Medicine, University of Colorado, 12631 E. 17th Ave., Mailstop B180, Aurora, CO, USA.
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA.
- Ludeman Family Center for Women's Health Research, Aurora, CO, USA.
| | - Nicole M Wagner
- Anschutz Medical Campus Department of Medicine, Division of General Internal Medicine, University of Colorado, 12631 E. 17th Ave., Mailstop B180, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
| | - Melanie Gleason
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - John T Brinton
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
| | - Michaela Brtnikova
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
| | - Sarah E Brewer
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anowara Begum
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
| | - Rachel Armstrong
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
| | - Lisa Ross DeCamp
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
| | - Arthur McFarlane
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - Heather DeKeyser
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - Holly Coleman
- Trailhead Institute, 1999 Broadway Suite 200, Denver, CO, 80202, USA
| | - Monica J Federico
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - Stanley J Szefler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - Lisa C Cicutto
- National Jewish Health and University of Colorado College of Nursing and Clinical Sciences, Aurora, CO, USA
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Brewer SE, Reedy J, Maestas D, DeCamp LR, Begum A, Brtnikova M, Cicutto L, Szefler SJ, Huebschmann A. Understanding Core Community Needs for School-Based Asthma Programming: A Qualitative Assessment in Colorado Communities. Ethn Dis 2023; DECIPHeR:35-43. [PMID: 38846724 PMCID: PMC11099527 DOI: 10.18865/ed.decipher.35] [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] [Indexed: 06/09/2024] Open
Abstract
Objectives Asthma is one of the most prevalent chronic conditions affecting approximately 8.5% of children in Colorado. Our school-based asthma program (SBAP) has effectively improved asthma control and reduced asthma disparities among children but has been largely limited to the Denver area. We interviewed community stakeholders in 5 regions of Colorado to understand community needs for broader dissemination of SBAPs. Methods In-depth, semistructured key informant interviews were conducted with school nurses, parents, pediatric healthcare providers, public health professionals, and community resource organization representatives. Inductive and deductive analyses were informed by the practical, robust, implementation, and sustainability model, an implementation science framework. Results Participants (n=52) identified 6 types of needs for successful future implementation of our SBAP: (1) buy-in from stakeholders; (2) asthma prioritization; (3) improved relationships, communication, and coordination among school nurses, healthcare providers, and community organizations that address social determinants of health (SDOH) and children/families; (4) resources to address healthcare and SDOH needs and awareness of existing resources; (5) asthma education for children/families, school staff, and community members; and (6) improved coordination for School Asthma Care Plan completion. These needs mapped to a 3-tiered, progressive structure of foundational, relational, and functional needs for implementation success. Conclusion These 6 types of needs illuminate factors that will allow this SBAP to work well and program delivery approaches and implementation strategies that may need modification to be successful. Next steps should include tailoring implementation strategies to variations in local context to support fit, effectiveness, and sustainment.
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Affiliation(s)
- Sarah E. Brewer
- ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Julia Reedy
- ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Danielle Maestas
- ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lisa Ross DeCamp
- ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Anowara Begum
- ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Michaela Brtnikova
- ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | | | - Stanley J. Szefler
- ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
- Breathing Institute, Children’s Hospital Colorado, Aurora, CO
| | - Amy Huebschmann
- ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, Anschutz Medical Campus, Aurora, CO
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Qian K, Xu H, Chen Z, Zheng Y. Advances in pulmonary rehabilitation for children with bronchial asthma. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:518-525. [PMID: 37643985 PMCID: PMC10495252 DOI: 10.3724/zdxbyxb-2023-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
Bronchial asthma is a heterogeneous disease characterized by chronic airway inflammation and airway hyperresponsiveness. With the development of the whole-life-cycle health concept, the focus of treatment for bronchial asthma in children has gradually shifted from pharmacological control to an integrated management model of functional rehabilitation and pharmacological assistance. As a non-pharmacological integrated approach, pulmonary rehabilitation plays an equally important role in the management of childhood asthma as pharmacological treatments. Breathing techniques such as Buteyko breathing, pursed lip breathing, diaphragmatic breathing training, threshold-pressure inspiratory muscle training and yoga breathing can improve lung function indicators such as forced expiratory volume in first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and maximal voluntary ventilation (MVV) in children. Comprehensive pre-exercise assessment, development of exercise prescriptions, and implementation and evaluation of exercise effects can improve physical fitness, neuromuscular coordination, and self-confidence of children with asthma. The comprehensive interventions of health education, psychological support and nutritional intervention can improve the compliance and effectiveness of rehabilitation training. This article reviews the research progress on respiratory training, physical exercise, and comprehensive interventions in the pulmonary rehabilitation of asthmatic children, to provide theoretical basis and practical guidance for the scientific and rational management of pulmonary rehabilitation of asthmatic children in clinical settings.
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Affiliation(s)
- Kongjia Qian
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.
| | - Hongzhen Xu
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.
| | - Zhimin Chen
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Ying Zheng
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
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Parker SJ, DeLaroche AM, Hill AB, Arora R, Gleason-Comstock J. Influenza vaccination coverage among an urban pediatric asthma population: Implications for population health. PLoS One 2022; 17:e0269415. [PMID: 36269718 PMCID: PMC9586375 DOI: 10.1371/journal.pone.0269415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/09/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Asthma is the most common chronic disease in children. Children with asthma are at high risk for complications from influenza; however annual influenza vaccination rates for this population are suboptimal. The overall aim of this study was to describe the characteristics of a high-risk population of children with asthma presenting to an urban pediatric emergency department according to influenza vaccination status. METHODS The study was a retrospective chart review of 4355 patients aged 2 to 18 years evaluated in a Michigan pediatric emergency department (PED) between November 1, 2017 and April 30, 2018 with an ICD-10-CM code for asthma (J45.x). Eligible patient PED records were matched with influenza vaccination records for the 2017-2018 influenza season from the Michigan Care Improvement Registry. Geospatial analysis was employed to examine the distribution of influenza vaccination status. RESULTS 1049 patients (30.9%) with asthma seen in the PED had received an influenza vaccine. Influenza vaccination coverage varied by Census Tract, ranging from 10% to >99%. Most vaccines were administered in a primary care setting (84.3%) and were covered by public insurance (76.8%). The influenza vaccination rate was lowest for children aged 5-11 years (30.0%) and vaccination status was associated with race (p<0.001) and insurance type (p<0.001). CONCLUSIONS Identification of neighborhood Census Tract and demographic groups with suboptimal influenza vaccination could guide development of targeted public health interventions to improve vaccination rates in high-risk patients. Given the morbidity and mortality associated with pediatric asthma, a data-driven approach may improve outcomes and reduce healthcare-associated costs for this pediatric population.
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Affiliation(s)
- Sarah J. Parker
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Amy M. DeLaroche
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, United States of America
| | - Alex B. Hill
- Department of Urban Studies and Planning, Wayne State University, Detroit, MI, United States of America
| | - Rajan Arora
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, United States of America
| | - Julie Gleason-Comstock
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States of America
- * E-mail:
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Szefler SJ, Cicutto L, Brewer SE, Gleason M, McFarlane A, DeCamp LR, Brinton JT, Huebschmann AG. Applying dissemination and implementation research methods to translate a school-based asthma program. J Allergy Clin Immunol 2022; 150:535-548. [PMID: 35569568 PMCID: PMC9590448 DOI: 10.1016/j.jaci.2022.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022]
Abstract
Our school-based asthma program has reduced asthma exacerbations for youth with health disparities in the Denver metropolitan area, due partly to addressing social determinants of health, such as access to health care and medications. Dissemination and implementation (D&I) science approaches accelerate the translation of evidence-based programs into routine practice. D&I methods are being applied more commonly to improve health equity. The purpose of this publication was to give an overview of D&I research methods, using our school-based asthma program as an example. To successfully scale out our program across the state of Colorado, we are applying a D&I framework that guides the adaptation of our existing implementation approach to better meet our stakeholders' local context-the Exploration, Preparation, Implementation, Sustainment framework. In a pragmatic trial design, we will evaluate the outcomes of implementing the program across 5 Colorado regions, with attention to health equity, using a second commonly used D&I framework-Reach, Effectiveness, Adoption, Implementation, and Maintenance. Our central hypothesis is that our program will have broad and equitable reach to eligible students (primary outcome) and will reduce asthma attacks and symptoms. This D&I approach accelerates dissemination of our program and is an applicable process for translating other effective allergy/asthma programs to address asthma and allergy-related disparities.
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Affiliation(s)
- Stanley J Szefler
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado Breathing Institute, Aurora, Colo; Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, Aurora, Colo.
| | - Lisa Cicutto
- National Jewish Health, Aurora, Colo; Clinical Science and College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Sarah E Brewer
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, Aurora, Colo; Department of Family Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Melanie Gleason
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado Breathing Institute, Aurora, Colo
| | | | - Lisa Ross DeCamp
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, Aurora, Colo; Latino Research and Policy Center, Colorado School of Public Health, Aurora, Colo
| | - John T Brinton
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado Breathing Institute, Aurora, Colo
| | - Amy G Huebschmann
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, Aurora, Colo; Department of Medicine, Division of General Internal Medicine, University of Colorado, Aurora, Colo; Ludeman Family Center for Women's Health Research, Aurora, Colo
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Davies SC, Lundine JP, Justice AF. Care Coordination for Children with Special Health Care Needs: A Scoping Review to Inform Strategies for Students with Traumatic Brain Injuries. THE JOURNAL OF SCHOOL HEALTH 2022; 92:270-281. [PMID: 34907533 DOI: 10.1111/josh.13132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/28/2021] [Accepted: 06/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Chronic and complex medical issues, including traumatic brain injuries (TBIs), have significant educational implications. The purpose of this study was to identify and summarize the literature on care coordination strategies among health care professionals, educators, and caregivers for children with special health care needs (CSHCN). Clarifying factors that influence care coordination for CSHCN can inform future studies on care coordination for students with TBI. Improved understanding of these factors may lead to better communication, reduction of unmet needs, more efficient service access, and improved long-term outcomes for children. METHODS A scoping review was conducted, guided by PRISMA-ScR methodology. Five databases (CINAHL, PSYCINFO, EMBASE, ERIC, PubMed) were searched to identify relevant studies that focused on care coordination and educational settings. RESULTS Twelve articles met inclusion criteria. Care coordination interventions for CSHCN used in educational settings focused on relationship-building strategies, clear procedures and roles, and education of members of the school community. CONCLUSIONS Findings highlight strategies to coordinate care for CSHCN and factors that may moderate effects of these interventions. Key stakeholders should now study these strategies specifically in children with TBI.
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Affiliation(s)
- Susan C Davies
- Department of Counselor Education and Human Services, University of Dayton, 300 College Park, Dayton, OH, 45469
| | - Jennifer P Lundine
- Department of Speech and Hearing Science, The Ohio State University Division of Clinical Therapies and Inpatient Rehabilitation, Nationwide Children's Hospital 101A Pressey Hall, 1070 Carmack RD, Columbus, OH, 43210
| | - Ann F Justice
- Department of Counselor Education and Human Services University of Dayton 300 College Park, Dayton, OH, 45469
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Francis L, DePriest K, Sharps P, Wilson P, Ling C, Bowie J, Thorpe RJ. A mixed-methods systematic review identifying, describing, and examining the effects of school-based care coordination programs in the US on all reported outcomes. Prev Med 2021; 153:106850. [PMID: 34662597 DOI: 10.1016/j.ypmed.2021.106850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/27/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
Children learn best when they are healthy. Therefore, access to school-based health and providing family support for social needs play an essential role in shaping a child's ability to succeed academically. The purpose of this mixed-methods review, which considers studies with all methods, is to describe and examine the effect of US school-based care coordination programs on all the outcomes reported. Care coordination is an organized approach to connect families to resources in the community to address social needs. The literature search identified 260 papers published since 2012 through CINAHL, ERIC, EMBASE, MEDLINE, Social Sciences Full Text, and Web of Science, from which 11 were included that described a US school-based care coordination program. An a priori organizing framework: Program Development, Implementation, and Evaluation were used to organize the findings. Whether quantitative or qualitative, all evaluation results were transformed into qualitative texts, then converted into codes then themes. Various health and learning issues such as asthma and vision screening were addressed. More than half of the care coordination programs were nurse-led. Parents and students characterized care coordination activities as convenient, trusting, and perceived to improve parent-teacher engagement. They also enhanced asthma knowledge and management, immunization adherence, follow-up care for vision and hearing, mental health, and school attendance. Nevertheless, challenges included staff shortages, unmet family needs, privacy laws regarding student data, and lack of resources (i.e., medications). This review highlights the need to expand school-based care coordination programs in the US and conduct robust program evaluations to assess their effectiveness.
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Affiliation(s)
- Lucine Francis
- Center for Community Programs, Innovation, and Scholarship, Hopkins Center for Health Disparities Solutions, Hopkins Consortium for School-Based Health Solutions, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205, United States of America.
| | - Kelli DePriest
- Center for Community Programs, Innovation, and Scholarship, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205, United States of America.
| | - Phyllis Sharps
- Center for Community Programs, Innovation, and Scholarship, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205, United States of America.
| | - Patty Wilson
- Center for Community Programs, Innovation, and Scholarship, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205, United States of America.
| | - Catherine Ling
- Center for Community Programs, Innovation, and Scholarship, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205, United States of America.
| | - Janice Bowie
- Hopkins Center for Health Disparities Solutions, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, United States of America.
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, United States of America.
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Bryant-Stephens T, Williams Y, Kanagasundaram J, Apter A, Kenyon CC, Shults J. The West Philadelphia asthma care implementation study (NHLBI# U01HL138687). Contemp Clin Trials Commun 2021; 24:100864. [PMID: 34926863 PMCID: PMC8649219 DOI: 10.1016/j.conctc.2021.100864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/05/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022] Open
Abstract
Asthma is the most common chronic condition among children, with low-income families living in urban areas experiencing significantly higher rates. Evidence based interventions for asthma are routinely implemented in either the home, school, or primary care setting. However, even when caregivers of poor children are engaged in asthma interventions in one setting, they often have to navigate challenges in another setting, such as an under-resourced home, non-supportive school, or disengaged health care provider. The West Philadelphia Asthma Care Implementation Plan aims to compare the effectiveness of a primary care-based intervention, school-based intervention, and combined primary care and school intervention to usual care for improving asthma control in school-age children to explore if the synergistic effect of Community Health Worker (CHW) support in the home, school, and health care environments will result in improved asthma control. Children ages 5-13 with uncontrolled asthma from four West Philadelphia recruitment sites will be eligible for enrollment. The families of school age children interested in participating will be randomized to receive a primary care CHW or usual care. Those identified as attending a participating school will have a CHW-led school intervention or usual care in school. If proven effective, this care coordination program will assist caregivers in assessing resources, improving self-management skills, and ultimately reducing asthma-related ED visits and hospitalizations as well as provide additional information for healthcare systems and policy makers to inform their decisions about how and where to focus additional resources and investments in childhood asthma care to improve health outcomes.
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Key Words
- ACQ, Asthma Control Questionnaire
- Asthma
- Asthma in children
- CAPP, Communitiy Asthma Prevention Program
- CHOP, Children's Hospital of Philadelphia
- CHW, Community Health Worker
- Community research
- EBI, Evidence-based intervention
- ED, emergency department
- EHR, electronic health record
- IRB, institutional review board
- Implementation science
- OAS, Open Airways for Schools
- SAMPRO, School-based Asthma Management Program
- SBAT, School-based Asthma Therapy
- WEPACC, West Philadelphia Asthma Care Collaborative
- pCHW, primary care community health worker
- sCHW, school-based community health worker
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Affiliation(s)
- Tyra Bryant-Stephens
- Community Asthma Prevention Program, Sr Director, Center for Health Equity, Associate Professor of Pediatrics, United States
| | | | | | - Andrea Apter
- Perelman School of Medicine at the University of Pennsylvania, United States
| | - Chén C. Kenyon
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, United States
| | - Justine Shults
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, United States
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Senter JP, Smith BM, Prichett LM, Connor KA, Johnson SB. Pediatric Asthma Is Associated With Poorer 3-Year Academic Achievement in Urban Elementary and Middle-School Students. Acad Pediatr 2021; 21:1009-1017. [PMID: 33207219 DOI: 10.1016/j.acap.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Asthma has been associated with worse academic performance in a single school year, yet this association may be magnified over time as students with asthma continue to fall behind. This study examined the relationship between asthma and standardized test performance aggregated across 3 school years, including whether performance varied by likelihood of having significant asthma. METHODS Data were from students in grades K-8 at 2 urban public schools in the Northeastern United States (2015-2018). Asthma was based on parent- and self-report and school health center records. Standardized test performance was assessed using Measures of Academic Progress (MAP) and Partnership for Assessment of Readiness for College and Careers (PARCC). Mixed effects linear and logistic regression models were used to evaluate the relationship between asthma and performance during 3 school years. RESULTS Any asthma was associated with worse MAP performance across the 3 academic years. Students with the most significant asthma demonstrated worse performance on MAP and PARCC. Aggregating across 3 school years, students scored 3.17 points worse on MAP reading (95% confidence interval [CI]: 0.7-5.63; P = .012) and 3.56 points worse on MAP mathematics (95% CI: 0.52-6.6; P = .022); they had 48.8% (95% CI: 1.9%-73.2%; P = .044) and 58.0% (95% CI: 21%-78%; P = .007) lower odds of proficiency on PARCC English/Language Arts and Mathematics, respectively compared to those without asthma. CONCLUSIONS The relationship between asthma and poorer academic achievement in 1 school year may be magnified over multiple years, particularly among those with more significant asthma. School-based asthma interventions may support academic growth and more equitable health outcomes.
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Affiliation(s)
- James P Senter
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md.
| | - Brandon M Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md
| | - Laura M Prichett
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md
| | - Katherine A Connor
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md
| | - Sara B Johnson
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md; Department of Population, Family & Reproductive Health and Mental Health, Johns Hopkins Bloomberg School of Public Health (SB Johnson), Baltimore, Md
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Jezioro JR, Gutman SA, Lovinsky-Desir S, Rauh V, Perera FP, Miller RL. A Comparison of Activity Participation between Children with and without Asthma. OPEN JOURNAL OF OCCUPATIONAL THERAPY 2021; 9. [PMID: 34316416 DOI: 10.15453/2168-6408.1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Asthma affects approximately 6 million children in the United States and can greatly impact quality of life and occupational engagement. Although occupational therapists are well-equipped to address participation limitations, insufficient evidence exists to support the role of occupational therapists in asthma treatment. Method The purpose of this study was to further understand the occupational limitations experienced by children with asthma. We also explored a dual diagnosis of asthma and obesity. The participants included children with (n = 84) and without (n = 63) asthma living in New York City. The Child Behavior Checklist, Youth Self Report, Brief Respiratory Questionnaire, and accelerometer data were used to examine occupational participation. Results Although accelerometry data demonstrated that children with asthma were equally as active as their non-asthmatic peers, the participants with asthma perceived themselves as participating more in sedentary occupations and were less likely to be members of sports teams. They also had more missed school days and nights of troubled sleep. The children with both asthma and obesity reported the highest level of activity limitations. Conclusion This study illustrates specific limitations experienced by children with asthma and supports the need for occupational therapy intervention. Future studies are needed to design and assess interventions that will support the addition of occupational therapists to multidisciplinary asthma treatment teams.
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11
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Banta JE, Ramadan M, Alhusseini N, Aloraini K, Modeste N. Socio-demographics and asthma prevalence, management, and outcomes among children 1-11 years of age in California. Glob Health Res Policy 2021; 6:17. [PMID: 34039445 PMCID: PMC8157798 DOI: 10.1186/s41256-021-00199-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Asthma disproportionately affects minority and low-income children. We examined asthma prevalence, management and outcomes, focusing on race/ethnicity and acculturation of parents (particularly English language proficiency). Methods This cross-sectional, correlational analysis used a de-identified population-based survey, the California Health Interview Survey, for years 2001–2015. Survey-weighted analysis with SAS 9.4 was used to determine asthma prevalence among children 1 to 11 years of age. Descriptive analysis was conducted, adjusting for survey design and combination of multiple years of data. The Pearson test, using design-based F values was used to determine statistically significant differences between those having/not having a doctor diagnosis of asthma. Multivariable logistic regression, with jackknife approach to obtain confidence intervals, was used to examine associations of child and parental characteristics with asthma prevalence, management, and outcomes. Results The 61,625 completed surveys represented an estimated annual population of 5.7 million children, of which 12.9 % had asthma. There were significant (p < 0.001) differences by age, gender, race, and language proficiency, with higher asthma prevalence for children 6 to 11 years of age (15.5 %), males (15.3 %), African Americans (19.5 %), and parents speaking English very well (14.1 %). Compared to children whose parents spoke English very well, those whose parents spoke English not well or not at all were less likely to achieve optimal asthma management, i.e. to have received a management plan from doctor (OR 0.30; 95 % Confidence Interval 0.20–0.46)), to be currently taking medication to control asthma (OR 0.52; 95 % CI 0.36–0.74)), or to be not confident in ability to control asthma (OR 3.10; 95 % CI 1.49–6.42). Children whose parents spoke English fairly well rather than very well had worse outcomes, i.e. were more likely to have an emergency room visit in past 12 months (OR 1.92; 95 % CI 1.03–3.61) and were more likely to miss school due to asthma in past 12 months (OR 0.71; 1.01–2.94). Conclusions Socio-demographics had a limited role in explaining differences across a handful of asthma management and outcome measures in California. Parental English language proficiency had the most consistent influence, underscoring the need for culturally and linguistically competent care.
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Affiliation(s)
- Jim E Banta
- Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA.
| | - Majed Ramadan
- Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA
| | - Noara Alhusseini
- College of Medicine, Alfaisal University, 7746 Ibrahim Alziady St., Alwurud District, 12253 2499, Riyadh, Saudi Arabia
| | - Khaled Aloraini
- Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA
| | - Naomi Modeste
- Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA
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Alharbi SA, Kobeisy SAN, AlKhater SA, Alharbi AS, Alqwaiee MM, Alotaibi FN, Alawam KA, Alahmadi TS, Al-Somali FM, Almaghamsi TM, Yousef AA. Childhood Asthma Awareness in Saudi Arabia: Five-Year Follow-Up Study. J Asthma Allergy 2020; 13:399-407. [PMID: 33061466 PMCID: PMC7537987 DOI: 10.2147/jaa.s272850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/03/2020] [Indexed: 01/01/2023] Open
Abstract
Background Bronchial asthma is a chronic inflammatory airway disease that is characterized by reversible airway obstruction due to bronchial hyperresponsiveness. It is one of the most common chronic diseases. In Saudi Arabia, asthma affects 2 million people with asthma frequency in children markedly higher than adults with regional variations ranging from 9% to 33.7%. Objective The aim of this study is to measure asthma awareness and knowledge of study participants during the ongoing annual Saudi asthma awareness campaigns and compare them with previous survey data conducted in 2014. Methods A cross-sectional study was carried out in the form of a survey distributed across three major cities in Saudi Arabia, Jeddah, Riyadh and Dammam, during the National Asthma Awareness Campaign in major regional shopping centers in April 2019. Asthma knowledge scores across different demographic groups were generated from surveyed data. Descriptive and correlative statistical analyses were performed to identify factors associated with changes in asthma knowledge. Scores were compared to previous survey results. Results The mean score for asthma knowledge was 15.6 out of 25. Asthma knowledge significantly correlated with age (P=0.002), asthma status of the participants (P=0.001), having children with asthma (P=0.005) or knowing friends or family with asthma (P=0.029) but not with other socioeconomic factors such as gender, marital status, occupation, level of education and number of children in the family (P > 0.05). There was a significant difference in the asthma scores from 2014 (M= 63%, SD=26) to 2019 (M= 70%, SD= 26) conditions; t (24) = -2.106, p=0.046. Conclusion Further educational campaigns are necessary to enhance and measure general public awareness of asthma, its differential diagnosis against other respiratory infections, environmental triggers, risk factors as well as treatment options.
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Affiliation(s)
- Saleh A Alharbi
- Department of Pediatrics, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.,Department of Pediatrics, Umm Al-Qura University, Mecca, Saudi Arabia
| | | | - Suzan A AlKhater
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Pediatrics, King Fahd Hospital of the University, AlKhobar, Saudi Arabia
| | - Adel S Alharbi
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | | | | | - Turki S Alahmadi
- Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Faisal M Al-Somali
- Department of Pediatrics, Sulaiman Al Habib Hospital, Al Khobar, Saudi Arabia
| | - Talal M Almaghamsi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdullah A Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.,Department of Pediatrics, King Fahd Hospital of the University, AlKhobar, Saudi Arabia
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13
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Everhart RS, Corona R, Mazzeo SE, Dempster KW, Schechter MS. School Nurses' Perspectives on Components of Asthma Programs to Address Pediatric Disparities. J Pediatr Psychol 2020; 45:900-909. [PMID: 32524136 PMCID: PMC7828575 DOI: 10.1093/jpepsy/jsaa039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/29/2020] [Accepted: 05/02/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To use a community engaged, collaborative approach with school nurses working within an urban community, to develop recommendations for future school-based interventions targeting pediatric asthma disparities. METHODS Open-ended survey data were collected from 33 nurses (77% of nurses in the school district) during a face-to-face monthly health services meeting. Questions asked nurses to estimate the proportion of students with asthma with the necessary forms and medications at school and to describe perceived barriers to having such forms and medications, and potential initiatives that could be implemented. A 30-min asthma education class was also piloted with school nurses, who then rated its acceptability and feasibility. Open-ended survey data were analyzed using thematic analysis. RESULTS Nurses estimated that 12% of students with asthma had an asthma action plan, 19% had a medication release form, and 15% had medications at school (i.e. inhalers). Four themes emerged regarding barriers to asthma management in schools and strategies for promoting asthma management in schools: coordination of care, asthma education, access to care, and medication adherence. Nurses noted the need for education focused specifically on teaching inhaler technique, and better communication between schools, providers, and families. CONCLUSIONS School nurses provided valuable information regarding specific barriers, as well as approaches to addressing these barriers in a future intervention. Findings suggest that a school-based intervention needs to address coordination among schools, parents, and medical providers, and will be optimally effective if it also addresses structural barriers.
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Affiliation(s)
| | - Rosalie Corona
- Department of Psychology, Virginia Commonwealth University and
| | | | | | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Children’s Hospital of Richmond at VCU
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14
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Allsopp L, Sterling DA, Spence E, Aryal S. Dissemination of Evidence-Based School Asthma Management Programs: Piloting Asthma 411 in an Urban Texas School District. THE JOURNAL OF SCHOOL HEALTH 2020; 90:594-603. [PMID: 32643214 DOI: 10.1111/josh.12909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 02/17/2020] [Accepted: 02/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The dissemination and implementation (D&I) of evidence-based initiative (EBIs) is critical to improved public health. The Asthma 411 EBI was piloted in Texas from 2013 to 2015. The pilot's evaluation assessed its effectiveness and identified approaches to support D&I of school-health EBIs. METHODS The pilot study was conducted in two schools; service categories included: a consulting physician, enhanced school asthma services, and support for links to community health resources. Data was collected on Emergency Medical Service (EMS) calls, aggregated nursing services, demographic characteristics, availability of medication provided through existing policies, and informal interviews. RESULTS During the pilot, school-day asthma-related Emergency Medical Service (EMS) calls were eliminated. Documented asthma self-management education, authorization for rescue medication, and efforts to communicate with parents and health providers increased. Between year-1 and year-2, the gap between unadjusted, weighted mean absences among students with and without asthma was reduced by 1.1 days. However, this difference was not seen in a fully adjusted negative, binomial regression model. CONCLUSIONS Evaluation of the Asthma 411 pilot suggests many EBI benefits were retained and identifies factors that may facilitate D&I of school health EBIs. Future research will clarify impacts on absenteeism and determine if observed benefits are sustained.
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Affiliation(s)
- Leslie Allsopp
- Asthma 411 Project Manager, , SaferCare Texas, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107
| | - David A Sterling
- Professor, Biostatistics & Epidemiology, , University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107
| | - Emily Spence
- Associate Dean for Community Engagement & Health Equity and Associate Professor, , University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107
| | - Subhash Aryal
- Director BECCA Lab & Research Associate Professor, , University of Pennsylvania, School of Nursing, 418 Curie Blvd, Philadelphia, Pennsylvania 19104; Senior Fellow, SaferCare Texas, 3500 Camp Bowie Blvd, Fort Worth, TX 76107
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15
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Kearney J, Everson L, Coppel J, Braithwaite S, Gibson L, Anderson B, George D, Cahilog Z, Chodhari R. Incorporating medical students into school-based asthma education improves asthma knowledge in children. J Asthma 2020; 58:1407-1413. [PMID: 32546028 DOI: 10.1080/02770903.2020.1784193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Asthma affects 1.1 million children in the UK, substantially impacting quality of life and leading to significant morbidity and mortality. Effective asthma self-management, education and empowerment can lead to a reduction in asthma related morbidity and mortality. We hypothesized that medical students can significantly improve school children's knowledge and awareness of asthma, at least in the short term. We sought to implement a medical student-led educational intervention program tailored to school-aged children, measure immediate improvements in asthma-related knowledge among participants, and determine if any population factors were associated with a difference in knowledge improvement.Methods: Children were recruited from schools in Greater London. A 20-minute presentation was given by medical students which covered basic physiology of asthma, triggers, treatment, how to recognize a peer who is having an acute asthma attack and common misconceptions about asthma. The children's knowledge was tested using questionnaires completed before and immediately after the presentation.Results: Medical students taught 1711 children aged 5 to 11 both with and without asthma. The average questionnaire score was 4.67/13 (SD 2.82) at baseline and 10.15/13 (SD 2.92) following the program. An improvement in scores was observed in all age groups and was greatest in children aged 10 and 11 (p = 0.016 and 0.049 respectively).Conclusion: We successfully implemented a medical student led asthma education program for school aged children in the UK. This novel approach was well received and led to a significant improvement in asthma knowledge amongst participants.
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Affiliation(s)
| | | | - Jonny Coppel
- University College London Centre for Altitude, Space, and Extreme Environment Medicine, University College London Hospitals National Institute for Health Research Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK
| | | | - Lucy Gibson
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | | | - Daniel George
- Medicine, St George's, University of London, London, UK
| | - Zhen Cahilog
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Rahul Chodhari
- Department of Child Health, The Royal Free NHS Foundation Trust, London, UK
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16
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Szefler SJ, Fitzgerald DA, Adachi Y, Doull IJ, Fischer GB, Fletcher M, Hong J, García‐Marcos L, Pedersen S, Østrem A, Sly PD, Williams S, Winders T, Zar HJ, Bush A, Lenney W. A worldwide charter for all children with asthma. Pediatr Pulmonol 2020; 55:1282-1292. [PMID: 32142219 PMCID: PMC7187318 DOI: 10.1002/ppul.24713] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
Abstract
Childhood asthma is a huge global health burden. The spectrum of disease, diagnosis, and management vary depending on where children live in the world and how their community can care for them. Global improvement in diagnosis and management has been unsatisfactory, despite ever more evidence-based guidelines. Guidelines alone are insufficient and need supplementing by government support, changes in policy, access to diagnosis and effective therapy for all children, with research to improve implementation. We propose a worldwide charter for all children with asthma, a roadmap to better education and training which can be adapted for local use. It includes access to effective basic asthma medications. It is not about new expensive medications and biologics as much can be achieved without these. If implemented carefully, the overall cost of care is likely to fall and the global future health and life chance of children with asthma will greatly improve. The key to success will be community involvement together with the local and national development of asthma champions. We call on governments, institutions, and healthcare services to support its implementation.
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Affiliation(s)
- Stanley J. Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, Pediatric Asthma Research Program, Anschutz Medical Campus, Breathing Institute, Children's Hospital ColoradoUniversity of Colorado School of MedicineAuroraColorado
| | - Dominic A. Fitzgerald
- Discipline of Child and Adolescent HealthSydney Medical School, University of SydneySydneyAustralia
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Yuichi Adachi
- Department of PediatricsUniversity of ToyamaToyamaJapan
| | - Iolo J. Doull
- Department of Paediatric Respiratory MedicineChildren's Hospital for WalesCardiffUK
| | - Gilberto B. Fischer
- Department of PaediatricsUniversidade Federal de Ciencias da Saúde de Porto AlegrePorto AlegreRio Grande do SulBrazil
| | - Monica Fletcher
- Asthma UK Centre for Applied ResearchUniversity of EdinburghEdinburghUK
| | - Jianguo Hong
- Department of Paediatrics, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Luis García‐Marcos
- Department of Paediatrics, “Virgen de la Arrixaca” University Children's HospitalUniversity of MurciaMurciaSpain
| | - Søren Pedersen
- Paediatric Research Unit, Kolding HospitalUniversity of Southern DenmarkKoldingDenmark
| | | | - Peter D. Sly
- Children's Health and Environment Program and World Health Organisation Collaborating Centre for Children's Health and Environment, Child Health Research CentreUniversity of QueenslandBrisbaneAustralia
| | - Siân Williams
- International Primary Care Respiratory GroupLondonUK
| | - Tonya Winders
- Allergy & Asthma NetworkViennaVirginia
- Global Allergy & Asthma Patient PlatformViennaVirginia
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalMRC Unit on Child & Adolescent Health, University of Cape TownCape TownSouth Africa
| | - Andy Bush
- Department of Paediatrics, National Heart and Lung Institute and Royal Brompton & Harefield NHS Foundation TrustImperial CollegeLondonUK
| | - Warren Lenney
- Department of Child Health, Institute of Applied Clinical ScienceKeele UniversityKeeleUK
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Kakumanu S, Lemanske RF. Asthma in Schools: How School-Based Partnerships Improve Pediatric Asthma Care. Immunol Allergy Clin North Am 2019; 39:271-281. [PMID: 30954176 DOI: 10.1016/j.iac.2018.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Children with asthma experience frequent exacerbations that require careful care coordination among families, clinicians, and schools. Prior studies have shown that children with asthma miss more school each year compared with their healthy peers due to uncontrolled asthma symptoms. Successful school-based asthma programs have built strong partnerships among patients, their families, and clinicians to improve communication and the dissemination of asthma action plans and medications to schools. The widely endorsed School-based Asthma Management Program, consisting of 4 components, provides a comprehensive and expert-supported framework to coordinate care with schools.
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Affiliation(s)
- Sujani Kakumanu
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, William S. Middleton Veterans Memorial Hospital, 600 Highland Avenue CSC 9988, Madison, WI 53792, USA.
| | - Robert F Lemanske
- Department of Pediatrics, Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, 4235 HSLC, 750 Highland Avenue, Madison, WI 53705, USA; Department of Medicine, Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, 4235 HSLC, 750 Highland Avenue, Madison, WI 53705, USA
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18
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Abstract
Childhood asthma affects many children placing them at significant risk for health care utilization and school absences. Several new developments relevant to the field of pediatric asthma have occurred over the last 5 years; yet, there is much more to learn. It is poorly understood how to prevent the disease, optimally address environmental challenges, or effectively manage poor adherence. Moreover, it is not clear how to customize therapy by asthma phenotype, age group, high risk groups, or severity of disease. Highlights of advances in pediatric asthma are reviewed and multiple essential areas for further exploration and research are discussed.
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Abstract
Asthma in inner-city children is often severe and difficult to control. Residence in poor and urban areas confers increased asthma morbidity even after adjusting for ethnicity, age, and gender. Higher exposure to household pests, such as cockroaches and mice, pollutants and tobacco smoke exposure, poverty, material hardship, poor-quality housing, differences in health care quality, medication compliance, and heath care access also contribute to increased asthma morbidity in this population. Since 1991, the National Institutes of Allergy and Infectious Diseases established research networks: the National Cooperative Inner-City Asthma Study (NCICAS), the Inner-City Asthma Study (ICAS), and the Inner-City Asthma Consortium (ICAC), to improve care for this at risk population. The most striking finding of the NCICAS is the link between asthma morbidity and the high incidence of allergen sensitization and exposure, particularly cockroach. The follow-up ICAS confirmed that reductions in household cockroach and dust mite were associated with reduction in the inner-city asthma morbidity. The ICAC studies have identified that omalizumab lowered fall inner-city asthma exacerbation rate; however, the relationship between inner-city asthma vs immune system dysfunction, respiratory tract infections, prenatal environment, and inner-city environment is still being investigated. Although challenging, certain interventions for inner-city asthma children have shown promising results. These interventions include family-based interventions such as partnering families with asthma-trained social workers, providing guidelines driven asthma care as well as assured access to controller medication, home-based interventions aim at elimination of indoor allergens and tobacco smoke exposure, school-based asthma programs, and computer/web-based asthma programs.
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20
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Isik E, Isik IS. Asthma care coordination in schools by school nurses: An integrative literature review. Public Health Nurs 2019; 36:498-506. [PMID: 30968440 DOI: 10.1111/phn.12610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/01/2019] [Accepted: 03/12/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this integrative literature review is to document and synthesize the available evidence on school nurse asthma care coordination challenges and explain the components of asthma care coordination/case management at schools. DESIGN The Whittemore and Knafl guidelines were followed for this integrative literature review. SAMPLE Twelve diverse primary sources-one qualitative study, eight quantitative studies, and three mixed-method studies-were used for the review. MEASUREMENTS Data were analyzed using the matrix method. RESULTS A total of 12 papers met the inclusion criteria. The initial group categorization was based on variables, patterns, and conceptual classification. Results were divided into two categorizations of asthma care coordination program components and asthma care coordination challenges at schools; subthemes were identified under the categorizations. CONCLUSIONS The results showed that care coordination was key for students with chronic diseases including asthma. Asthma care coordination has many challenges, but school nurses can drive effective asthma care by including the essential components of care coordination. Successful asthma care coordination may prevent health care fragmentation, emergency room visits, hospitalization, and school absenteeism, and can increase asthma knowledge and the quality of life for students and parents.
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Affiliation(s)
- Elif Isik
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas.,School Nurse in Houston Independent School District, Briarmeadow Charter School, Houston, Texas
| | - Ismet S Isik
- Information Technology, Harmony Public Schools, Houston, Texas
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21
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Asthma in inner city children: recent insights: United States. Curr Opin Allergy Clin Immunol 2019; 18:139-147. [PMID: 29406360 DOI: 10.1097/aci.0000000000000423] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Children living in US inner cities experience disparate burdens of asthma, especially in severity, impairment, exacerbations, and morbidity. Investigations seeking to better understand the factors and mechanisms underlying asthma prevalence, severity, and exacerbation in children living in these communities can lead to interventions that can narrow asthma disparities and potentially benefit all children with asthma. This update will focus on recent (i.e. late 2016-2017) advances in the understanding of asthma in US inner city children. RECENT FINDINGS Studies published in the past year expand understanding of asthma prevalence, severity, exacerbation, and the outcomes of guidelines-based management of these at-risk children, including: asthma phenotypes in US inner city children that are severe and difficult-to-control; key environmental determinants and mechanisms underlying asthma severity and exacerbations (e.g. allergy-mediated exacerbation susceptibility to rhinovirus); the importance of schools as a place for provocative exposures (e.g. mouse allergen, nitrogen dioxide) as well as a place where asthma care and outcomes can be improved; and the development and validation of clinically useful indices for gauging asthma severity and predicting exacerbations. SUMMARY These recent studies provide a trove of actionable findings that can improve asthma care and outcomes for these at-risk children.
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Harris K, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database Syst Rev 2019; 1:CD011651. [PMID: 30687940 PMCID: PMC6353176 DOI: 10.1002/14651858.cd011651.pub2] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Asthma is a common respiratory condition in children that is characterised by symptoms including wheeze, shortness of breath, chest tightness, and cough. Children with asthma may be able to manage their condition more effectively by improving inhaler technique, and by recognising and responding to symptoms. Schools offer a potentially supportive environment for delivering interventions aimed at improving self-management skills among children. The educational ethos aligns with skill and knowledge acquisition and makes it easier to reach children with asthma who do not regularly engage with primary care. Given the multi-faceted nature of self-management interventions, there is a need to understand the combination of intervention features that are associated with successful delivery of asthma self-management programmes. OBJECTIVES This review has two primary objectives.• To identify the intervention features that are aligned with successful intervention implementation.• To assess effectiveness of school-based interventions provided to improve asthma self-management among children.We addressed the first objective by performing qualitative comparative analysis (QCA), a synthesis method described in depth later, of process evaluation studies to identify the combination of intervention components and processes that are aligned with successful intervention implementation.We pursued the second objective by undertaking meta-analyses of outcomes reported by outcome evaluation studies. We explored the link between how well an intervention is implemented and its effectiveness by using separate models, as well as by undertaking additional subgroup analyses. SEARCH METHODS We searched the Cochrane Airways Trials Register for randomised studies. To identify eligible process evaluation studies, we searched MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Database of Systematic Reviews (CDSR), Web of Knowledge, the Database of Promoting Health Effectiveness Reviews (DoPHER), the Database of Abstracts of Reviews of Effects (DARE), the International Biography of Social Science (IBSS), Bibliomap, Health Technology Assessment (HTA), Applied Social Sciences Index and Abstracts (ASSIA), and Sociological Abstracts (SocAbs). We conducted the latest search on 28 August 2017. SELECTION CRITERIA Participants were school-aged children with asthma who received the intervention in school. Interventions were eligible if their purpose was to help children improve management of their asthma by increasing knowledge, enhancing skills, or changing behaviour. Studies relevant to our first objective could be based on an experimental or quasi-experimental design and could use qualitative or quantitative methods of data collection. For the second objective we included randomised controlled trials (RCTs) where children were allocated individually or in clusters (e.g. classrooms or schools) to self-management interventions or no intervention control. DATA COLLECTION AND ANALYSIS We used qualitative comparative analysis (QCA) to identify intervention features that lead to successful implementation of asthma self-management interventions. We measured implementation success by reviewing reports of attrition, intervention dosage, and treatment adherence, irrespective of effects of the interventions.To measure the effects of interventions, we combined data from eligible studies for our primary outcomes: admission to hospital, emergency department (ED) visits, absence from school, and days of restricted activity due to asthma symptoms. Secondary outcomes included unplanned visits to healthcare providers, daytime and night-time symptoms, use of reliever therapies, and health-related quality of life as measured by the Asthma Quality of Life Questionnaire (AQLQ). MAIN RESULTS We included 55 studies in the review. Thirty-three studies in 14,174 children provided information for the QCA, and 33 RCTs in 12,623 children measured the effects of interventions. Eleven studies contributed to both the QCA and the analysis of effectiveness. Most studies were conducted in North America in socially disadvantaged populations. High school students were better represented among studies contributing to the QCA than in studies contributing to effectiveness evaluations, which more commonly included younger elementary and junior high school students. The interventions all attempted to improve knowledge of asthma, its triggers, and stressed the importance of regular practitioner review, although there was variation in how they were delivered.QCA results highlighted the importance of an intervention being theory driven, along with the importance of factors such as parent involvement, child satisfaction, and running the intervention outside the child's own time as drivers of successful implementation.Compared with no intervention, school-based self-management interventions probably reduce mean hospitalisations by an average of about 0.16 admissions per child over 12 months (SMD -0.19, 95% CI -0.35 to -0.04; 1873 participants; 6 studies, moderate certainty evidence). They may reduce the number of children who visit EDs from 7.5% to 5.4% over 12 months (OR 0.70, 95% CI 0.53 to 0.92; 3883 participants; 13 studies, low certainty evidence), and probably reduce unplanned visits to hospitals or primary care from 26% to 21% at 6 to 9 months (OR 0.74, 95% CI 0.60 to 0.90; 3490 participants; 5 studies, moderate certainty evidence). Self-management interventions probably reduce the number of days of restricted activity by just under half a day over a two-week period (MD 0.38 days 95% CI -0.41 to -0.18; 1852 participants; 3 studies, moderate certainty evidence). Effects of interventions on school absence are uncertain due to the variation between the results of the studies (MD 0.4 fewer school days missed per year with self-management (-1.25 to 0.45; 4609 participants; 10 studies, low certainty evidence). Evidence is insufficient to show whether the requirement for reliever medications is affected by these interventions (OR 0.52, 95% CI 0.15 to 1.81; 437 participants; 2 studies; very low-certainty evidence). Self-management interventions probably improve children's asthma-related quality of life by a small amount (MD 0.36 units higher on the Paediatric AQLQ(95% CI 0.06 to 0.64; 2587 participants; 7 studies, moderate certainty evidence). AUTHORS' CONCLUSIONS School-based asthma self-management interventions probably reduce hospital admission and may slightly reduce ED attendance, although their impact on school attendance could not be measured reliably. They may also reduce the number of days where children experience asthma symptoms, and probably lead to small improvements in asthma-related quality of life. Many of the studies tested the intervention in younger children from socially disadvantaged populations. Interventions that had a theoretical framework, engaged parents and were run outside of children's free time were associated with successful implementation.
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Affiliation(s)
- Katherine Harris
- Queen Mary University of LondonCentre for Child Health, Blizard InstituteLondonUKE1 2AT
| | - Dylan Kneale
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
| | - Toby J Lasserson
- Cochrane Central ExecutiveEditorial & Methods DepartmentSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Vanessa M McDonald
- The University of NewcastleSchool of Nursing and Midwifery, Priority Reseach Centre for Asthma and Respiratory DiseaseLocked Bag 1000New LambtionNewcastleNSWAustralia2305
| | - Jonathan Grigg
- Queen Mary University of LondonCentre for Child Health, Blizard InstituteLondonUKE1 2AT
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
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Pappalardo AA, Paulson A, Bruscato R, Thomas L, Minier M, Martin MA. Chicago Public School nurses examine barriers to school asthma care coordination. Public Health Nurs 2018; 36:36-44. [PMID: 30569556 DOI: 10.1111/phn.12574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/19/2018] [Accepted: 11/14/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE/DESIGN Well documented asthma disparities in Chicago pose a continual challenge for the Chicago Public Schools (CPS). Coordinated Healthcare for Complex Kids (CHECK) is a health care demonstration project funded by a Centers for Medicare and Medicaid Services Health Care Innovation Award. A collaborative partnership was formed between CHECK and CPS. With CHECK support, CPS administered a survey to 160 nurses to understand the asthma problems nurses perceived and interest in intervention. RESULTS Seventy-five per cent (n = 120) completed the survey. While asthma was the top diagnosis managed by 95%, 72% reported gaps in asthma understanding. Appropriate communication between school nurses and providers occurred 33% of the time; 18% believed they received sufficient support to follow-up on deficient paperwork. The barriers mentioned were lack of medications (73%), time (67%), and communication with providers (61%). When asked their opinions on potential interventions, 78% of nurses supported web-based applications, 66% community health workers (CHW), and 66% stock albuterol in schools. CONCLUSIONS The greatest barriers for CPS nurses with asthma management are time and communication. Potential interventions such as web-based communication applications and CHW in schools were well received.
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Affiliation(s)
- Andrea A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois.,Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Allison Paulson
- School of Public Health, University Chicago Medical Center, Chicago, Illinois
| | - Robin Bruscato
- Chicago Public Schools Nursing Administration, Chicago, Illinois
| | - Leretha Thomas
- Chicago Public Schools Nursing Administration, Chicago, Illinois
| | - Mark Minier
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Molly A Martin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
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24
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The Unfulfilled Promise of School-Centered Asthma Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 4:980-1. [PMID: 27587323 DOI: 10.1016/j.jaip.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 06/01/2016] [Indexed: 11/24/2022]
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Szefler SJ, Cloutier MM, Villarreal M, Hollenbach JP, Gleason M, Haas-Howard C, Vinick C, Calatroni A, Cicutto L, White M, Williams S, McGinn M, Langton C, Shocks D, Mitchell H, Stempel DA. Building Bridges for Asthma Care: Reducing school absence for inner-city children with health disparities. J Allergy Clin Immunol 2018; 143:746-754.e2. [PMID: 30055181 DOI: 10.1016/j.jaci.2018.05.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/16/2018] [Accepted: 05/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with asthma are at increased risk for experiencing health and educational disparities because of increased school absence. School nurses are well positioned to support asthma management and improve school attendance. OBJECTIVE We sought to implement and assess the effect of the Building Bridges for Asthma Care Program on improving school attendance and measures of asthma control. METHODS Children with asthma (age, 5-14 years) in the Denver Public School System (n = 240) and the Hartford Public School System (n = 223) were enrolled in the Building Bridges Program during the 2013-2014 and 2014-2015 school years and followed until the end of the second school year. The primary outcome was school absence, with secondary outcomes, including asthma control, measured based on Childhood Asthma Control Test or the Asthma Control Test scores and rescue inhaler use. RESULTS Participants experienced a 22% absolute decrease in school absenteeism, the number of children with an Asthma Control Test/Childhood Asthma Control Test score of less than the control threshold of 20 decreased from 42.7% to 28.8%, and bronchodilator use greater than 2 times per week decreased from 35.8% to 22.9% (all changes were significant, P < .01). CONCLUSIONS Children enrolled in the Building Bridges for Asthma Care Program experienced reduced school absence and improved asthma control.
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Affiliation(s)
- Stanley J Szefler
- Pediatric Asthma Research Program and the Breathing Institute, Children's Hospital Colorado, and the Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colo.
| | - Michelle M Cloutier
- Pediatrics and Medicine, UCONN Health, and the Asthma Center, Connecticut Children's Medical Center, Hartford, Conn
| | | | - Jessica P Hollenbach
- Department of Pediatrics, University of Connecticut School of Medicine, and the Asthma Center, Connecticut Children's Medical Center, Hartford, Conn
| | - Melanie Gleason
- Building Bridges Asthma Program, Children's Hospital Colorado, and the Department of Pediatrics, Section of Pediatric Pulmonary Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Christy Haas-Howard
- Denver Public Schools, Nursing and Student Health Services, and the Colorado Department of Education, Asthma Grant Program, Denver, Colo
| | - Carol Vinick
- Building Bridges Coordinator, Asthma Center, and the Connecticut Children's Medical Center, Hartford, Conn
| | | | - Lisa Cicutto
- Community Outreach and Research, National Jewish Health, and the Clinical Science Program, University of Colorado Denver AMC, Denver, Colo
| | - Marty White
- Children's Hospital Colorado/Denver Public Schools, Denver, Colo
| | | | | | - Christine Langton
- Building Bridges Coordinator, Asthma Center, and the Connecticut Children's Medical Center, Hartford, Conn
| | - Donna Shocks
- Denver Public Schools, Nursing and Student Health Services, Denver, Colo
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26
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Szefler SJ. Asthma across the lifespan: Time for a paradigm shift. J Allergy Clin Immunol 2018; 142:773-780. [PMID: 29627424 DOI: 10.1016/j.jaci.2018.03.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/12/2018] [Accepted: 03/23/2018] [Indexed: 12/25/2022]
Abstract
We have a unique opportunity to significantly reduce the worldwide burden of asthma in children and affect respiratory outcomes in adults. However, this will require a paradigm shift that is directed at altering the natural history of asthma, reducing asthma exacerbations, and preventing long-term adverse outcomes of childhood asthma. Attention should continue to be directed toward minimizing risk, as well as impairment, with a goal to achieve optimal control. Based on several National Institutes of Health studies conducted over the last 10 years, we now have the tools necessary to accomplish this goal. The tools include assessment of lung function over time or defining trajectories of lung growth, the Composite Asthma Severity Index score, a panel of useful biomarkers, the Seasonal Asthma Exacerbation Prediction Index score, and rapidly advancing technology that includes adherence monitoring. Future guideline revisions should consider incorporating recommendations to follow spirometry over time and defining trajectories of lung growth to assess risk for reduced lung growth and early decline, asthma burden by using biomarkers to select and monitor therapy, assessment of social determinants of health, evaluation of risk for seasonal exacerbations, and consideration of electronic adherence monitoring for difficult-to-manage asthma. Guidelines should continue to include a core dedicated to the diagnosis and treatment of intermittent and mild and moderate persistent asthma and include additional sections dedicated to the management of severe asthma.
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Affiliation(s)
- Stanley J Szefler
- Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
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27
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Allen ED, Arcoleo K, Rowe C, Long WW. Implementation of a "real world" School-Based Asthma Therapy program targeting urban children with poorly controlled asthma. J Asthma 2017; 55:1122-1130. [PMID: 29190172 DOI: 10.1080/02770903.2017.1396472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Describe implementation and clinical impact of a "real world" School-Based Asthma Therapy (SBAT) Program serving an urban, largely Medicaid population in a large midwestern city in the United States. METHODS A retrospective, descriptive evaluation of SBAT was conducted. Students were referred by school nurses or providers, enrolled throughout the year, and could reenroll in subsequent years. A total of 286 students participated in the 2015-2016 school year. Kruskal-Wallis nonparametric testing compared Asthma Control Test™ (ACT) scores from enrollment (anytime between 2013 and 2015) to 2015-2016 for 198 students; and pre- and postenrollment asthma-related emergency department (ED), inpatient, and critical care (pediatric intensive care unit or PICU) utilization rates (events/student/year) for 98 students enrolled for a full year. RESULTS SBAT participation grew from 17 to 131 schools and from 38 to 268 students between 2013-2014 and 2015-2016. Mean ACT scores increased from 16.2 (SD = 4.89) to 21.37 (SD = 3.41) (K-W χ2 = 35.45, p = 0.008). Healthcare utilization rates from 1-year preenrollment to 1-year postenrollment decreased for ED (0.91-0.44; K-W χ2 = 18.61, p = 0.0002) and Inpatient (0.38-0.10; K-W χ2 = 7.68, p = 0.02). Reduction in PICU (0.27-0.02) was not statistically significant. CONCLUSIONS SBAT, modeled after programs shown in controlled trials to improve asthma health markers ( 1-3 ), was successfully implemented in economically challenged, urban schools. Rapid growth and patient reenrollment reflect program acceptance by schools, providers, and caregivers. Improved ACT scores and healthcare utilization supported program efficacy. SBAT could be one solution to improved asthma control in underserved school-aged pediatric patients.
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Affiliation(s)
- Elizabeth D Allen
- a Physician Lead, Asthma Quality Improvement, Nationwide Children's Hospital , Division of Pulmonary Medicine , Columbus , OH , USA
| | - Kimberly Arcoleo
- b Associate Professor & Associate Dean for Research , University of Rochester, School of Nursing , Rochester , NY , USA
| | - Courtney Rowe
- c School Based Asthma Therapy (SBAT) Program Nurse Practitioner , Nationwide Children's Hospital , Columbus , OH , USA
| | - William W Long
- d Associate Administrative Medical Director , Nationwide Children's Hospital , Columbus , OH , USA
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28
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Gleason M, Cicutto L, Haas-Howard C, Raleigh BM, Szefler SJ. Leveraging Partnerships: Families, Schools, and Providers Working Together to Improve Asthma Management. Curr Allergy Asthma Rep 2017; 16:74. [PMID: 27709456 DOI: 10.1007/s11882-016-0655-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Asthma is one of the most common illnesses of school-aged children and can lead to both health and educational disparities. Children from low socioeconomic backgrounds and racial/ethnic minorities suffer the greatest impact. They often lack the asthma self-management skills to successfully monitor, navigate, and negotiate appropriate asthma care. School settings are a strategic point of contact for this additional support. School nurses can monitor for signs of asthma worsening, manage symptoms, provide care coordination, and reinforce self-management skills. Likewise, school-based asthma programs have the potential to reduce health and educational disparities, but it is the strong linkage to the asthma care provider that is critical to successful school-based asthma management. Healthcare providers are encouraged to establish partnerships with families through patient-centered care and schools through clear communication and care coordination to ensure asthma is well controlled so the child is in school and ready to learn.
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Affiliation(s)
- Melanie Gleason
- University of Colorado School of Medicine, Section of Pulmonary Medicine, Aurora, CO, USA. .,Childrens' Hospital Colorado, Breathing Institute, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Lisa Cicutto
- Clinical Science Program, University of Colorado Denver AMC, Denver, CO, USA.,National Jewish Health, Denver, CO, USA
| | | | - Bridget M Raleigh
- University of Colorado School of Medicine, Section of Pulmonary Medicine, Aurora, CO, USA.,Childrens' Hospital Colorado, Breathing Institute, 13123 East 16th Avenue, Aurora, CO, 80045, USA
| | - Stanley J Szefler
- University of Colorado School of Medicine, Section of Pulmonary Medicine, Aurora, CO, USA.,Childrens' Hospital Colorado, Breathing Institute, 13123 East 16th Avenue, Aurora, CO, 80045, USA
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29
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Anderson WC, Apter AJ, Dutmer CM, Searing DA, Szefler SJ. Advances in asthma in 2016: Designing individualized approaches to management. J Allergy Clin Immunol 2017; 140:671-680. [PMID: 28709967 DOI: 10.1016/j.jaci.2017.06.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 12/12/2022]
Abstract
In this year's Advances in Asthma review, we discuss viral infections in asthmatic patients and potential therapeutic agents, the microbiome, novel genetic associations with asthma, air quality and climate effects on asthma, exposures during development and long-term sequelae of childhood asthma, patient-centered outcomes research, and precision medicine. In addition, we discuss application of biomarkers to precision medicine and new information on asthma medications. New evidence indicates that rhinovirus-triggered asthma exacerbations become more severe as the degree of sensitization to dust mite and mouse increase. The 2 biggest drivers of asthma severity are an allergy pathway starting with allergic sensitization and an environmental tobacco smoke pathway. In addition, allergic sensitization and blood eosinophils can be used to select medications for management of early asthma in young children. These current findings, among others covered in this review, represent significant steps toward addressing rapidly advancing areas of knowledge that have implications for asthma management.
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Affiliation(s)
- William C Anderson
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Andrea J Apter
- Section of Allergy & Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Cullen M Dutmer
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Daniel A Searing
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Stanley J Szefler
- Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
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