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Sheikh SI, Ryan-Wenger NA, May A, Krivchenia K, Pitts J. Impact of type of health care provider on long term asthma control. J Asthma 2021; 59:1012-1020. [PMID: 33600737 DOI: 10.1080/02770903.2021.1892750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Asthma prevalence is high and adherence to asthma guidelines is still less than adequate. The main objective of this study was to determine if there were significant differences in outcome measures if asthma care was provided per guidelines either by physicians (pediatric pulmonologists) or specialty trained advance practice nurses (APNs). METHODS This was a three-year, prospective cohort study of children referred by their primary care providers to a tertiary care center for better asthma control. Patients were provided asthma care per NAEPP guidelines including asthma education. Results were compared over time and between patients followed by physicians or APNs. Alpha level of significance was ≤0.05. RESULTS The sample included 471 children, ages 2-17 years (mean = 6.4 ± 2.4 years). Physicians and APN's provided asthma care. Of the 471 children enrolled in the study, 176 (37%) were followed for the full three-year study period. At the initial visit, physician group reported more short courses of oral steroids and more unscheduled visits to PCP for acute asthma care in the past 6 months compared to those followed by APNs (<0.05 for all). Among the total cohort and both subgroups, there were significant improvements in mean Asthma Control Test (ACT), acute care need and mean days/month with asthma symptoms over a three-year period (p < 0.05). There was significantly more improvement in use of oral steroids and urgent care visits in physician group (p < 0.05). CONCLUSION When asthma guidelines are followed, improvements in asthma control are achieved in children in both the MD and APN groups.
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Affiliation(s)
- Shahid I Sheikh
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Nancy A Ryan-Wenger
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anne May
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Katelyn Krivchenia
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Judy Pitts
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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Black LV, Ezmigna D, Wallace-Farquharson T, Wilkie DJ, Duckworth L. Feasibility and preliminary outcomes of an integrated pediatric sickle cell disease and pulmonary care clinic for children with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28672. [PMID: 32886403 DOI: 10.1002/pbc.28672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND In children with sickle cell disease (SCD), comorbid asthma is associated with increased disease severity and morbidity, but it remains underdiagnosed and optimal management paradigms are not well defined. The purpose of this study was to determine the feasibility and preliminary outcomes of an integrated pediatric SCD and pulmonary care clinic in children with SCD. METHODS We implemented a pre-post quality improvement (QI) project in our pediatric hematology clinic between 2017 and 2019. Guided by the chronic care model, patients who were ages 2-18 years, diagnosed with SCD and suspected pulmonary comorbidities, received care in an interdisciplinary clinic. We examined feasibility and compared clinical outcomes to 24 months prior (2015-2017) to the implementation of the integrated care model. RESULTS Twenty-four patients were included in the QI project: 88% (n = 21) received pulmonary function testing, 92% (n = 22) were diagnosed with asthma, and 33% (n = 8) with obstructive sleep apnea. Adherence to pulmonary appointments was increased by 81% (mean difference [MD] = 1.3, 95% confidence interval [CI] = 0.71-1.92; P < .001). Unplanned acute health care utilization was reduced by 59% (MD = 2.9, 95% CI = 1.14-4.69; P < .01) and packed red blood cell transfusion was reduced by 81% (MD = 1.38, 95% CI = 0.71-2.04; P < .001). CONCLUSION Asthma is prevalent in children with SCD, and interdisciplinary clinics can improve access to subspecialty pulmonary care and reduce unplanned acute care. Additional patients and a longer follow-up period are required to determine the true treatment effect.
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Affiliation(s)
- L Vandy Black
- Department of Pediatric Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida
| | - Dima Ezmigna
- Department of Pediatrics/Pediatric Pulmonology, College of Medicine, University of Florida, Gainesville, Florida
| | - Tanya Wallace-Farquharson
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Laurie Duckworth
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
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De Filippo M, Clark E, Fillard A, Diaferio L, Caimmi D. Oral corticosteroids and asthma in children: Practical considerations. Pediatr Allergy Immunol 2020; 31 Suppl 24:43-45. [PMID: 32017205 DOI: 10.1111/pai.13151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 12/01/2022]
Abstract
Corticosteroids (CS) are among the most prescribed drugs in pediatrics. In allergy, CS are prescribed for several different conditions. If CS show clear benefits when adequately prescribed, CS are also associated with several side effects, well known by pediatricians. As for asthma exacerbations, the oral route is always the preferred one in pediatrics. Several authors debated if the use of a single dose of dexamethasone is better in terms of efficacy, compared with a 3- to 5-day course of prednisone or prednisolone. Another interesting issue that has not been fully clarified concerns whether oral corticosteroids should be prescribed in preschoolers presenting with acute wheezing. The present review aims to review the most recent publications on this topic and to try to clarify which may be the best option in children suffering from asthma exacerbations.
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Affiliation(s)
- Maria De Filippo
- Allergy Unit, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Univ Montpellier, Montpellier, France.,Pediatric Unit of the University Hospital of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Evangéline Clark
- Allergy Unit, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Univ Montpellier, Montpellier, France
| | - Anouchka Fillard
- Allergy Unit, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Univ Montpellier, Montpellier, France
| | - Lucia Diaferio
- Department of Pediatrics, Aldo Moro University of Bari, Giovanni XXIII Hospital, Bari, Italy
| | - Davide Caimmi
- Allergy Unit, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Univ Montpellier, Montpellier, France.,Equipe EPAR - IPLESP, UMR 1136, INSERM - Sorbonne Université, Paris, France
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Weinberger M, Hendeles L, Abu-Hasan M. Oral corticosteroids should be available on-hand at home for the next asthma exacerbation! Ann Allergy Asthma Immunol 2018; 121:18-21. [PMID: 29653237 DOI: 10.1016/j.anai.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 03/30/2018] [Accepted: 04/02/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Miles Weinberger
- Pediatric Department, University of California-San Diego, Rady Children's Hospital, San Diego, California.
| | - Leslie Hendeles
- Pediatric Department, University of Florida, Gainesville, Florida
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Sadreameli SC, Alade RO, Mogayzel PJ, McGrath-Morrow S, Strouse JJ. Asthma Screening in Pediatric Sickle Cell Disease: A Clinic-Based Program Using Questionnaires and Spirometry. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2017; 30:232-238. [PMID: 29279789 DOI: 10.1089/ped.2017.0776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 10/23/2017] [Indexed: 01/31/2023]
Abstract
A clinician diagnosis of asthma is associated with increased morbidity and mortality in people with sickle cell disease (SCD). We hypothesized that a screening program would help identify children with asthma needing referral to pulmonary clinic. We conducted a single-center project to screen patients with SCD for asthma using a previously validated questionnaire (Breathmobile) and for pulmonary function abnormalities with portable spirometry. Participants with a positive questionnaire and/or abnormal spirometry were referred to pediatric pulmonary clinic. We evaluated clinical associations with abnormal spirometry and questionnaire responses. Of the 157 participants, 58 (37%) had a positive asthma screening questionnaire. Interpretable spirometry was available for 105 (83% of those eligible) and of these, 35 (34%) had abnormal results. The asthma questionnaire was 87.5% sensitive [95% confidence interval (CI) 74.8-95.3] and 85.3% specific (95% CI 77.3-91.4) to detect a clinician diagnosis of asthma. Participants with positive questionnaires were older (mean age 12.2 vs. 9.9 years, P = 0.012). Spirometry identified 16 additional participants who had normal asthma questionnaires. Seventy-four participants (47%) were referred to pediatric pulmonary clinic and 25 (34%) of these participants scheduled clinic appointments; however, only 13 (52%) were evaluated in pulmonary clinic. Clinic-based asthma screening and spirometry frequently identified individuals with asthma and pulmonary function abnormalities. Only 22% of those referred were eventually seen in pulmonary clinic. The impact of improved screening and treatment on the pulmonary morbidity in SCD needs to be defined and is an area for future investigation. In addition, case management or multidisciplinary clinics may enhance future screening programs.
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Affiliation(s)
- Sara C Sadreameli
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel O Alade
- Division of Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter J Mogayzel
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sharon McGrath-Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John J Strouse
- Division of Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Collins AD, Beigelman A. An update on the efficacy of oral corticosteroids in the treatment of wheezing episodes in preschool children. Ther Adv Respir Dis 2014; 8:182-90. [PMID: 25294845 DOI: 10.1177/1753465814552283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Traditionally, oral corticosteroids (OCSs) have been the mainstay of treatment for acute wheezing episodes among preschool children with a history of recurrent wheezing. Although there is substantial evidence for the efficacy of OCSs as a treatment for asthma exacerbations in school-aged children and adolescents, recent clinical studies questioned the benefits of OCSs as a treatment for acute wheezing in preschool children. This review summarizes the current evidence on the efficacy of OCSs as a treatment for acute wheezing episodes among preschool age children with episodic wheezing, focusing on studies performed in three different settings: OCS treatment initiated by parents in the outpatient setting, OCS treatment initiated in the emergency department (ED), and OCS treatment among hospitalized preschool children. The results of most studies reviewed in this paper do not support the efficacy of OCS treatment among preschool children with recurrent wheezing. The heterogeneity of early childhood wheezing and asthma might be part of the explanation for lack of efficacy of this intervention noted in multiple studies.
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Affiliation(s)
| | - Avraham Beigelman
- Division of Allergy, Immunology and Pulmonary Medicine. Department of Pediatrics. Washington University School of Medicine. 660 S. Euclid Ave. Campus Box 8116 St. Louis, MO 63110
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Gold LS, Yeung K, Smith N, Allen-Ramey FC, Nathan RA, Sullivan SD. Asthma control, cost and race: results from a national survey. J Asthma 2013; 50:783-90. [PMID: 23638955 DOI: 10.3109/02770903.2013.795589] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Although interventions have been shown to alleviate symptoms in most patients suffering from asthma, only one-third of asthma patients have disease that is well-controlled. The purpose of this study is to investigate whether partly and uncontrolled asthmas are associated with increased costs for asthma-related healthcare utilization compared to well-controlled asthma and to determine whether these associations differed across racial groups. METHODS We classified respondents from the Asthma Insights and Management survey into those with well-, partly and uncontrolled asthma and compared utilization of healthcare services and costs among these groups, as well as between whites and non-whites. RESULTS Respondents categorized as having asthma that was not well-controlled reported lower income levels, higher rates of unemployment and more trouble paying for healthcare; similar results were found in analyses stratified by race. Patients whose asthma was partly or uncontrolled had greater use of asthma-related medications and medical services compared to patients whose asthma was well-controlled. Total unadjusted and adjusted costs were greater in patients whose asthma was classified as partly and uncontrolled. Similar results were found in analyses stratified on race. Across all levels of asthma control, non-whites had higher rates of utilization of emergency rooms and urgent care facilities and had greater rates of hospitalizations compared to whites. CONCLUSIONS Our findings indicate that patients with asthma that is not well-controlled utilized more healthcare resources and had greater medical costs, despite lacking of health insurance which may suggest less access to care.
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Affiliation(s)
- Laura S Gold
- Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA 98195-9455, USA.
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8
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Weinberger M. NHLBI asthma guidelines: no benefit for patients? Pediatr Pulmonol 2012; 47:632-4. [PMID: 22081515 DOI: 10.1002/ppul.21593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 09/23/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Miles Weinberger
- Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242, USA.
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Scott L, Morphew T, Bollinger ME, Samuelson S, Galant S, Clement L, O'Cull K, Jones F, Jones CA. Achieving and maintaining asthma control in inner-city children. J Allergy Clin Immunol 2011; 128:56-63. [PMID: 21531451 DOI: 10.1016/j.jaci.2011.03.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 03/17/2011] [Accepted: 03/18/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite guidelines-defined care, inner-city children of low socioeconomic status have poor asthma control. OBJECTIVE This study evaluated time to achieve control, maintenance of control, and factors associated with well controlled asthma for pediatric patients receiving specialty-based asthma care in mobile asthma clinics designed to reduce barriers to delivering effective asthma care (the Breathmobile Program). METHODS Existing clinical data collected from January 1998 to June 2008 for 7822 pediatric patients with asthma (34,339 visits) enrolled in similarly structured mobile asthma programs across the United States evaluated the effect of asthma control on the reduction of asthma-related morbidity, time to achieve asthma control, maintenance of asthma control, and factors associated with well controlled asthma. RESULTS Comparison of pre and post year data for subjects enrolled in the program for at least 1 year revealed reductions in the percentage of patients reporting emergency department visits (mean, 66%), hospitalizations (mean, 84%), and missed school days ≥5/year (mean, 78%). Well controlled asthma was achieved by visit 3 for an estimated 80% of patients. Factors contributing to well controlled asthma include non-African American race, visit interval <90 days, and adherence to prescribed therapy. CONCLUSION This study demonstrates the ability to achieve and maintain asthma control in high-risk populations in association with intensive, accessible, guidelines-defined care with close follow-up.
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Affiliation(s)
- Lyne Scott
- Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.
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10
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Bollinger ME, Morphew T, Mullins CD. The Breathmobile program: a good investment for underserved children with asthma. Ann Allergy Asthma Immunol 2011; 105:274-281. [PMID: 20934626 DOI: 10.1016/j.anai.2010.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 07/15/2010] [Accepted: 07/25/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Breathmobile, a specialty-based mobile asthma clinic, provides free care to underserved children. The cost of symptom-free day (SFD) improvement in this population has not been previously reported. OBJECTIVE To examine the clinical impact and cost-effectiveness of the Baltimore Breathmobile. METHODS Existing computerized data were analyzed for Breathmobile patient visits between 2002 and 2007. All SFDs were calculated, and direct medical cost savings attributable to decreased emergency department visits and hospitalizations (after program utilization vs the previous year) were compared with annual operating costs. Incremental cost-effectiveness ratios were determined by calculating the incremental costs of Breathmobile care per additional SFD gained per child per year. RESULTS The analysis included 255 patients enrolled in the program for at least 1 year. Most participants were black (93.3%), and 54.9% were male. At baseline, patients reported a mean (SD) of 199 (118) SFDs in the year before enrollment. After 1 year in the program, patients had a mean (SD) improvement of 44 (9) SFDs. The program resulted in overall cost savings of $79.43 per SFD gained, with greater cost savings for children aged 5 to 11 years (-$116.84 per SFD gained) and those with intermittent asthma (-$126.71 per SFD gained). CONCLUSIONS The Baltimore Breathmobile program has demonstrated significant improvement in SFDs, with direct medical cost savings of the program outweighing the operational costs. These data support the need to continue to sustain and expand Breathmobile programs for children at high risk for asthma exacerbations and to conduct a randomized clinical trial to estimate the cost-effectiveness of the Breathmobile.
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Affiliation(s)
- Mary Elizabeth Bollinger
- Division of Pediatric Pulmonology/Allergy, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Zethraeus N, Petersson CJ, Dozzi M, Borres MP, Vignati G, Fiocchi A. Health-care cost reduction resulting from primary-care allergy testing in children in Italy. Ital J Pediatr 2010; 36:61. [PMID: 20836868 PMCID: PMC2945355 DOI: 10.1186/1824-7288-36-61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 09/13/2010] [Indexed: 11/13/2022] Open
Abstract
Background Allergy places a considerable cost burden on society. Specific immunoglobulin E (spIgE) testing may improve the management of allergy patients. There is therefore a reason to quantify the economic consequences of the use of spIgE testing in the diagnosis of allergic conditions. Methods The expected costs of spIgE testing versus no-testing were calculated using a clinical decision model based on a prospective clinical trial performed in primary care. Results The expected costs per patient over 2 years decreased from 802 euros in the "no-test strategy" to 560 euros in the spIgE "test strategy". Cost savings persisted even after assumptions about the prevalence of allergy and the prices of medications were changed. The "test strategy" increased the percentage of patients correctly diagnosed from 54 to 87%. Conclusions spIgE testing of children with respiratory and/or skin problems in primary care in Italy reduces overall costs to society. These cost savings mostly result from a reduction in the use of medications, particularly corticosteroids. The study indicates that spIgE testing of all children with respiratory and/or skin symptoms would be a cost-effective strategy.
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Affiliation(s)
- Niklas Zethraeus
- Medical Management Centre, Institution for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Rose G, Gilbert TE, Thame M, Bailey K. Asthma clinic attendance improves quality of life of Jamaican asthmatic children and their parents. ACTA ACUST UNITED AC 2009; 29:203-8. [PMID: 19689862 DOI: 10.1179/027249309x12467994693897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND With the increasing incidence of paediatric asthma, there has been a corresponding increase in the physical, emotional and financial burden. This has led to a greater interest in determining the impact of asthma and its treatment on many aspects of patient functioning and wellbeing. AIM To assess the usefulness of the Asthma Clinic established in Jamaica in 1997 by ascertaining whether there has been improvement in quality of life of children and care-givers who attend the clinic. METHODS The quality of life of patients and their parents/care-givers before attending the Asthma Clinic of Bustamante Hospital for Children in Kingston, Jamaica was compared with that of 1 year afterwards. Parents or guardians were interviewed using the Pediatric Asthma Quality of Life Questionnaire which consists of three domains [symptoms (ten questions), emotional (eight questions) and activity (five questions)] and the Pediatric Asthma Caregiver's Quality of life Questionnaire which consist of two domains [emotional (nine questions) and activity (four questions)]. RESULTS Quality of life improved in patients and their parents/care-givers in all domains. CONCLUSION Attendance at an asthma clinic in Jamaica improved the quality of life of asthmatic children and their parents/care-givers.
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Affiliation(s)
- G Rose
- The Bustamante Hospital for Children, Kingston, Jamaica, West Indies
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Schnitman RC, Farris J, Smith SR. Follow-up Care for Children With Asthma After Emergency Department Visits. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2009. [DOI: 10.1016/j.cpem.2009.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Seventeen years of asthma guidelines: why hasn't the outcome improved for children? J Pediatr 2009; 154:786-8. [PMID: 19446095 DOI: 10.1016/j.jpeds.2009.01.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Revised: 12/08/2008] [Accepted: 01/06/2009] [Indexed: 11/22/2022]
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Association between skin testing in the pediatric emergency department and adherence to follow-up in children with asthma. Ann Allergy Asthma Immunol 2009; 102:35-40. [PMID: 19205283 DOI: 10.1016/s1081-1206(10)60105-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Efforts to enroll inner-city asthmatic children into continuity care after a pediatric emergency department (PED) visit are frequently unsuccessful. Providing parents with documentation of their child's allergic status and how this can be used to tailor an asthma management plan may improve adherence to scheduled continuity appointments. OBJECTIVE To determine whether skin testing children during PED visits for wheezing and providing parents with skin test results improves adherence to follow-up visits. METHODS A convenience sample of children aged 2 to 12 years with asthma who presented to the PED with wheezing were eligible. Enrolled children were randomized to group 1 (no skin test) or group 2 (skin test). At discharge, both groups scheduled asthma clinic appointments for within 1 week. Children in group 2 underwent skin testing with standard allergens, and parents were given documentation of skin test results. Adherence was assessed by computer confirmation of the patient's asthma clinic visit. RESULTS Seventy-seven children were enrolled: 39 in group 1 and 38 in group 2. The mean age was 7 years; 69% had mild intermittent asthma. Twenty-four percent of children (9 of 38) in group 1 vs 46% (17 of 37) in group 2 were followed up in the asthma clinic (P < .05). Children in group 2 were 2.6 (95% confidence interval, 1.02-6.65) times more likely to keep appointments compared with children in group 1. CONCLUSIONS Parents who receive evidence in the PED of their child's allergic status and probable relationship to the child's asthma are more likely to adhere to scheduled continuity visits.
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Weinberger M. Pediatric asthma and related allergic and nonallergic diseases: patient-oriented evidence-based essentials that matter. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17455111.2.5.631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Asthma is the most common medical diagnosis among hospitalized children. In the USA, asthma has accounted for approximately 15% of nonsurgical admissions to hospital in the pediatric age group. Asthma is also one of the leading causes for emergency care requirements, one of the leading causes for missed school, and a cause for considerable morbidity, disability and occasional mortality at all ages. Despite these discouraging statistics, convincing data indicate that this failure of asthma management is not the result of inadequate therapeutic potential, but instead represents ineffective delivery of medical care. Management of asthma and its major co-morbidities, allergic and nonallergic rhinitis, and atopic dermatitis requires a knowledge of the alternative therapies, natural history, and educational techniques for providing patients and families with the ability to manage these troublesome chronic disorders.
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Affiliation(s)
- Miles Weinberger
- University of Iowa Children’s Hospital, Director, Pediatric Allergy & Pulmonary Division, Iowa City, IA 52242, USA
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Smith SR, Wakefield DB, Cloutier MM. Relationship between pediatric primary provider visits and acute asthma ED visits. Pediatr Pulmonol 2007; 42:1041-7. [PMID: 17902163 DOI: 10.1002/ppul.20694] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the relationship between primary care provider visits and emergency department (ED) asthma visits for urban, minority children. DESIGN This is a retrospective review of eligibility files and Medicaid claims for children with asthma from 1999 to 2001. PARTICIPANTS Children 24 months through 17 years of age with Medicaid or state health insurance, who resided in Hartford, Connecticut, and had persistent asthma, were included. OUTCOME MEASURES The primary outcome was the number of ICD-9 asthma-related primary care visits in the 12-month period before asthma ED visits. Secondary outcomes included the number of filled prescriptions for controller medications 3 and 12 months before emergency asthma visits. RESULTS One thousand four hundred seventy-four children met study criteria. Children with a greater number of asthma-related primary care visits during the previous 12 months were less likely to have asthma-related ED visits in 2000 and 2001 (both years P < 0.001). Children with an asthma-related ED visit had fewer primary care visits (for any reason) in 2000 but not in 2001 (P < 0.01). In 2000, the odds that children with 3 or more asthma-related primary care visits and a filled inhaled corticosteroid (ICS) had an asthma ED visit were 1/5 those of children with fewer asthma-related PCP visits or no filled ICS (OR = 0.20, 95% CI (0.06, 0.65)). Fewer than 17% of all children with asthma-related ED visits filled any prescription for controller medications in the 3 months before these visits. CONCLUSION Asthma-related primary care visits are associated with fewer asthma-related ED visits in urban children.
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Affiliation(s)
- Sharon R Smith
- Division of Emergency Medicine, Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, USA.
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Weinberger M. Improving care for asthma. J Pediatr 2005; 147:411; author reply 412-3. [PMID: 16182690 DOI: 10.1016/j.jpeds.2005.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Accepted: 03/04/2005] [Indexed: 11/20/2022]
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