1
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Wedel N, Zinger N, Singh AK, Kaur S, Njeze O, Cosar E, Mowrey W, Green S, Reznik M, Feldman J, Su Z, Ansari A, Elrington C, Mathur M, Zheng K, Jariwala SP. ASTHMAXcel PRO patient satisfaction and usability field testing. J Asthma 2024; 61:813-822. [PMID: 38226774 DOI: 10.1080/02770903.2024.2304615] [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: 11/06/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
Background: ASTHMAXcel PRO, an enhanced version of the ASTHMAXcel mobile application, has been developed to deliver comprehensive, guideline-based asthma education while also facilitating the collection of patient-reported outcomes (PROs) and enhancing user experience. Objective: To perform field testing and conduct formative and summative evaluation of the ASTHMAXcel PRO application to assess its impact on patient satisfaction, usability, and usage. Methods: Twenty-eight adult patients completed a baseline visit during which ASTHMAXcel PRO was introduced, health literacy was assessed, and demographic data were collected. They were instructed to use the app for 4 weeks. The Questionnaire for User Interface Satisfaction (QUIS) and the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire were administered at baseline and 4 weeks to assess user satisfaction and technology acceptance, respectively. Semi-structured interviews were conducted to gather feedback regarding the application from patients. Results: The baseline total scores were high for both UTAUT and QUIS (mean (SD): 64.2 (10.1), 6.8 (2.2) respectively) indicating that user satisfaction and acceptance began at high levels. UTAUT total score, as well as all domain scores, improved significantly from baseline to 4 weeks (p < 0.02). QUIS total score along with several domain scores (screen, system capabilities, usability) also increased from baseline to 4-weeks (p = 0.03, 0.01, 0.03, 0.01, respectively). These improvements remained significant when adjusting for age, gender, education, and health literacy. Patients reported that the application was helpful, informative, and easy to understand and use. Conclusion: The significant increases in satisfaction and technology adoption observed among ASTHMAXcel PRO users demonstrate that the application is viable and has the potential to improve upon usability challenges faced by existing mobile health applications.
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Affiliation(s)
- Nicole Wedel
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Nicole Zinger
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Anjani K Singh
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Savneet Kaur
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Obumneme Njeze
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Emine Cosar
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Wenzhu Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Samuel Green
- Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marina Reznik
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Jonathan Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Montefiore Medical Group, Montefiore Medical Center, Bronx, NY, USA
| | - Zhaoyuan Su
- Department of Informatics, University of CA Irvine, Irvine, CA, USA
| | - Asif Ansari
- Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carol Elrington
- Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Manuja Mathur
- Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kai Zheng
- Department of Informatics, University of CA Irvine, Irvine, CA, USA
| | - Sunit P Jariwala
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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2
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Soumagne T, Chenivesse C, Didier A, Giovannini-Chami L, Magnan A, Taillé C. [Written action plans for asthma control: How are they used by pulmonologists in France?]. Rev Mal Respir 2024; 41:102-109. [PMID: 38228440 DOI: 10.1016/j.rmr.2024.01.001] [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: 10/05/2023] [Accepted: 12/06/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Despite evidence of the benefits of the written asthma action plans (WAP) in asthma control, they remain poorly applied. The aim of our study was to assess the practices of French-speaking pulmonologists and paediatricians in their use of WAP for asthma control and to analyse the contents of several WAPs routinely consulted in treatment of asthma patients. METHODS Members of three French medical societies (SPLF, G2A, SP2A) were requested to share their WAPs for asthma patients and to participate in an online survey about the possible influence of these documents on their practices. RESULTS Most (95%) of the 41 WAPs taken into consideration were symptom-based and 34% included peak expiratory flow measurement. All of these action plans were in full compliance with current guidelines. Among the 110 survey respondents, while 65% systematically provided a WAP to their asthma patients, only 30% often or always supplemented the written document with therapeutic education sessions. In almost every case, it was the doctor who presented the WAP to the patient, generally devoting to less than 10minutes to explanation of what they were handing out. CONCLUSIONS In France, WAPs are generally presented to the patient by the physician, which probably limits the time devoted to explanation of their contents. Furthermore, WAPs are rarely reinforced with therapeutic education. The current study suggests ways of improving the utilization of WAPs in asthma care and treatment.
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Affiliation(s)
- T Soumagne
- Service de pneumologie et de soins intensifs, hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - C Chenivesse
- Service de pneumologie et d'immuno-allergologie, hôpital Albert Calmette, CHRU de Lille, Lille, France; University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - A Didier
- Service de pneumologie/allergologie, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | | | - A Magnan
- Service de pneumologie, hôpital Foch, Suresnes, université de Versailles Saint-Quentin, Paris-Saclay, France
| | - C Taillé
- Service de pneumologie, Groupe Hospitalier Universitaire AP-HP Nord-Université Paris Cité, Hôpital Bichat, Inserm UMR1152, Paris, France.
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3
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Leviton A, Patel AD, Loddenkemper T. Self-management education for children with epilepsy and their caregivers. A scoping review. Epilepsy Behav 2023; 144:109232. [PMID: 37196451 DOI: 10.1016/j.yebeh.2023.109232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023]
Abstract
Self-management education programs have been highly successful in preparing people to manage medical conditions with recurring events. A detailed curriculum for epilepsy patients, and their caretakers, is lacking. Here we assess what is available for patients who have disorders with recurring events and offer an approach to developing a potential self-care curriculum for patients with seizures and their caregivers. Among the anticipated components are a baseline efficacy assessment and training tailored to increasing self-efficacy, medication compliance, and stress management. Those at risk of status epilepticus will also need guidance in preparing a personalized seizure action plan and training in how to decide when rescue medication is appropriate and how to administer the therapy. Peers, as well as professionals, could teach and provide support. To our knowledge, no such programs are currently available in English. We encourage their creation, dissemination, and widespread use.
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Affiliation(s)
- Alan Leviton
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Anup D Patel
- Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, USA.
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4
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Herman ST, Detyniecki K, O'Hara K, Penovich P, Rao VR, Tatum W, Long L, Stern JM, Carrazana E, Rabinowicz AL. Written seizure action plans for adult patients with epilepsy: Distilling insights from emergency action plans for other chronic conditions. Epilepsy Behav 2023; 140:109002. [PMID: 36822041 DOI: 10.1016/j.yebeh.2022.109002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 02/25/2023]
Abstract
Seizure emergencies and potential emergencies, ranging from seizure clusters to prolonged seizure and status epilepticus, may affect adults with epilepsy despite stable antiseizure therapy. Seizure action plans (SAPs) are designed for patients and their caregivers/care partners to provide guidance on the individualized treatment plan, including response to potential seizure emergencies and appropriate use of rescue therapy. The use of pediatric SAPs is common (typically required by schools), however, most adults with epilepsy do not have a plan. Patient-centered action plans are integral to care for other chronic conditions and may offer insights applicable to the care of adults with epilepsy. This review analyzes the potential benefits of action plans for medical conditions by exploring their utility in conditions such as asthma, diabetes, chronic obstructive pulmonary disease, heart disease, and opioid overdose. Evidence across these conditions substantiates the value of action plans for patients, and the benefits of adult SAPs in epilepsy are emerging. Because wide implementation of SAPs has faced barriers, other conditions may provide insights that are relevant to implementing SAPs in epilepsy. Based on these analyses, we propose concrete steps to improve the use of SAPs among adults. A recent consensus statement promoting the use of formal SAPs in epilepsy and advances in rescue therapy delivery methods provides support to engage patients around the value of SAPs. The precedent for use of SAPs for pediatric epilepsy patients serves as the foundation to support increased usage in adults. Seizure action plans in the context of improved clinical outcomes are expected to reduce healthcare utilization, improve patient quality of life, and optimize epilepsy management.
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Affiliation(s)
- Susan T Herman
- Barrow Neurological Institute, Phoenix, AZ, United States.
| | | | | | | | - Vikram R Rao
- University of California San Francisco, San Francisco, CA, United States
| | | | | | - John M Stern
- University of California Los Angeles, Los Angeles, CA, United States
| | - Enrique Carrazana
- University of Hawaii John A. Burns School of Medicine, Honolulu, HI, United States; Neurelis, Inc, San Diego, CA, United States
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5
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Soumagne T, Barnig C, Perotin-Collard JM, Taillé C. [An action plan for everyone !]. Rev Mal Respir 2023; 40:306-307. [PMID: 36746702 DOI: 10.1016/j.rmr.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 02/05/2023]
Affiliation(s)
- T Soumagne
- Service de pneumologie et de soins intensifs, hôpital européen Georges Pompidou, AP-HP, 20, rue Leblanc, Paris, France.
| | - C Barnig
- Service de pneumologie, oncologie thoracique et allergologie respiratoire, CHU de Besançon, Besançon, France; CRISALIS, F-CRIN Inserm network, France
| | - J-M Perotin-Collard
- CRISALIS, F-CRIN Inserm network, France; Service des maladies respiratoires et allergiques, CHU de Reims, Reims, France
| | - C Taillé
- CRISALIS, F-CRIN Inserm network, France; Service de pneumologie, groupe hospitalier universitaire, AP-HP Nord-Université Paris Cité, Hôpital Bichat, Inserm UMR1152, Paris, France
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6
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Chan A, Kodali S, Lee GY, Gadhave S, Feldman JM, Arora S, Pawar S, Gadkari R, Bargaje M, Salvi S, Jariwala SP. Evaluating the effect and user satisfaction of an adapted and translated mobile health application ASTHMAXcel© among adults with asthma in Pune, India. J Asthma 2023:1-11. [PMID: 36511602 DOI: 10.1080/02770903.2022.2155188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE ASTHMAXcel© is a mobile application previously shown to improve asthma knowledge, control, and quality of life. In this study, we translated the application to Marathi for pilot testing in Pune, India in order to evaluate its impact on user satisfaction and asthma knowledge among adult asthma patients. METHODS ASTHMAXcel© was adapted to Marathi with the help of asthma patients and clinicians from Bharati Hospital. 57 different asthma patients were then recruited and received the Asthma Knowledge Questionnaire (AKQ), Asthma Control Questionnaire (ACQ), and Mini Asthma Quality of Life Questionnaire (Mini-AQLQ) to complete at baseline. Study participants then completed the adapted ASTHMAXcel© application. Post-intervention, participants filled out a post-AKQ and Questionnaire for User Interface Satisfaction (QUIS). A subset of participants was also interviewed for qualitative feedback. Paired t-tests and Pearson's correlation were used for statistical analysis. RESULTS Mean AKQ improved from 5.0+/-2.4 to 12.4+/-1.6 (p = 0.0001). QUIS results revealed that participants were highly satisfied with the application, scoring an average of 50 out of 54 maximum points. Better baseline asthma control was correlated with greater overall experience with the application (-0.110, p = 0.0417). Finally, the qualitative feedback revealed four themes for future refinement. CONCLUSION The adapted version of ASTHMAXcel© was linked to significant improvement in patient asthma knowledge and a high level of user satisfaction. These results support the potential utility of mHealth applications in promoting guideline-based asthma care in India. However, further studies are needed to establish a causal relationship between ASTHMAXcel© and improved clinical outcomes.
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Affiliation(s)
- Austin Chan
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sruthi Kodali
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Grace Y Lee
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Swapnil Gadhave
- Pulmocare Research and Education (PURE) Foundation, Pune, Maharashtra, India.,Respiratory Research Network (RRN), Pune, Maharashtra, India
| | - Jonathan M Feldman
- Departments of Pediatrics and Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shitij Arora
- Department of Medicine Inpatient Digital Innovation, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shrikant Pawar
- Chest Research and Training Pvt. Ltd. (CREST), Pune, Maharashtra, India
| | - Rashmi Gadkari
- Chest Research and Training Pvt. Ltd. (CREST), Pune, Maharashtra, India.,International Network for Lung Oscillometry Research (ARISE), Pune, Maharashtra, India
| | - Medha Bargaje
- Department of Pulmonary Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
| | - Sundeep Salvi
- Chest Research and Training Pvt. Ltd. (CREST), Pune, Maharashtra, India.,Faculty of Health Sciences, Symbiosis International University, Pune, Maharashtra, India
| | - Sunit P Jariwala
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
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7
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A systematic review on the effectiveness and impact of clinical decision support systems for breathlessness. NPJ Prim Care Respir Med 2022; 32:29. [PMID: 35987745 PMCID: PMC9392800 DOI: 10.1038/s41533-022-00291-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractBreathlessness is a common presenting symptom in practice. This systematic review aimed to evaluate the impact of CDSS on breathlessness and associated diseases in real-world clinical settings. Studies published between 1 January 2000 to 10 September 2021 were systematically obtained from 14 electronic research databases including CENTRAL, Embase, Pubmed, and clinical trial registries. Main outcomes of interest were patient health outcomes, provider use, diagnostic concordance, economic evaluation, and unintended consequences. The review protocol was prospectively registered in PROSPERO (CRD42020163141). A total of 4294 records were screened and 37 studies included of which 30 were RCTs. Twenty studies were in primary care, 13 in hospital outpatient/emergency department (ED), and the remainder mixed. Study duration ranged from 2 weeks to 5 years. Most were adults (58%). Five CDSS were focused on assessment, one on assessment and management, and the rest on disease-specific management. Most studies were disease-specific, predominantly focused on asthma (17 studies), COPD (2 studies), or asthma and COPD (3 studies). CDSS for COPD, heart failure, and asthma in adults reported clinical benefits such as reduced exacerbations, improved quality of life, improved patient-reported outcomes or reduced mortality. Studies identified low usage as the main barrier to effectiveness. Clinicians identified dissonance between CDSS recommendations and real-world practice as a major barrier. This review identified potential benefits of CDSS implementation in primary care and outpatient services for adults with heart failure, COPD, and asthma in improving diagnosis, compliance with guideline recommendations, promotion of non-pharmacological interventions, and improved clinical outcomes including mortality.
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8
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Afolabi T, Fairman KA. Association of Asthma Exacerbation Risk and Physician Time Expenditure With Provision of Asthma Action Plans and Education for Pediatric Patients. J Pediatr Pharmacol Ther 2022; 27:244-253. [PMID: 35350158 DOI: 10.5863/1551-6776-27.3.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/14/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To provide information about factors underlying provision of asthma action plans (AAPs) to a minority of pediatric patients with asthma, assess whether risk of exacerbation acts on provision of AAP and asthma education directly, suggesting targeting to highest-risk patients, or indirectly by influencing physician-patient interaction time. METHODS This study was a retrospective cross-sectional analysis of a nationally representative sample of physician office visits that consisted of patients aged 2 to 18 years with asthma. Exacerbation risk comprised proxy indicators of control and severity. Direct and time-mediated effects of exacerbation risk on provision of AAP and education were calculated from logistic regression models. RESULTS Asthma action plans were provided in 14.3% of visits, education in 23.9%. Total direct effects of exacerbation risk (ORs = 3.88-4.69) far exceeded indirect, time-mediated effects (both ORs = 1.03) on AAPs. Direct effects on education were similar but smaller. After adjusting for risk, physician time expenditure of ≥30 minutes was associated with nearly doubled odds of providing AAP or education (ORs = 1.90-1.99). Visits that included allied health professionals alongside physician care were significantly associated with all 4 outcomes in multivariate analyses (ORs = 3.06-5.28). CONCLUSIONS Exacerbation risk has a strong, direct association with AAP provision in pediatric asthma, even controlling for physician time expenditure. Provision of AAP and education to pediatric patients with asthma may be facilitated by increasing available time for office visits and involving allied health professionals.
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Affiliation(s)
- Titilola Afolabi
- Midwestern University College of Pharmacy-Glendale (TA, KAF), Glendale, AZ.,Phoenix Children's Hospital (TA), Phoenix, AZ
| | - Kathleen A Fairman
- Midwestern University College of Pharmacy-Glendale (TA, KAF), Glendale, AZ
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9
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Miles LM, Ducharme FM, Collin J, Blais L, Bacon SL, Lavoie KL, McKinney ML, Peláez S. Physician's perspective regarding asthma guided self-management: directives or guidance? J Asthma 2021; 59:1263-1268. [PMID: 33877960 DOI: 10.1080/02770903.2021.1914652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Asthma guided self-management enhances patients' control of their condition under the guidance of the treating physician. The aim of the present study was to understand how physicians perceive, endorse, uptake, and support asthma guided self-management. METHODS We conducted a secondary supplementary analysis of data originally collected as part of a multicenter collective case study in which physicians treating patients with asthma were interviewed. Using reflective thematic analysis, we aimed to explore physicians' understanding of guided asthma self-management as related to four ideas, namely: (a) understanding of the disease management and treatment goals; (b) defining medical frame and guidance; (c) describing the importance of patient-physician relationship; and (d) implementing asthma guided self-management. RESULTS Evidence indicates that physicians perceived optimal guided self-management as related to patients' adherence to physician's instructions and recommendations, supported by the adjustment of prescribed pharmaceutical therapy contingent upon patient's symptoms. Some physicians also perceived behavior change and environmental control along with the medical recommendations. While physicians' perception of asthma and its treatment were aligned with the recommended guidelines-i.e., patient-centered care approach based on guided self-management, the actual guidance offered to patients remained primarily directive and paternalistic. Non-pharmacological approaches, such as exercise, smoking cessation, patient self-monitoring, and self-management supported by education and written self-management plans, were given little consideration in the context of the recommended treatment plan.
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Affiliation(s)
- Laura May Miles
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Francine M Ducharme
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada.,Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Johanne Collin
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Lucie Blais
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.,Montreal Behavioural Medicine Centre, CIUSS-NIM, Hopital du Sacré-Coeur de Montreal, Montreal, Quebec, Canada
| | - Kim L Lavoie
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Martha L McKinney
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Sandra Peláez
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada.,School of Kinesiology and Physical Activity Sciences (EKSAP), Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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10
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Hsia BC, Singh AK, Njeze O, Cosar E, Mowrey WB, Feldman J, Reznik M, Jariwala SP. Developing and evaluating ASTHMAXcel adventures: A novel gamified mobile application for pediatric patients with asthma. Ann Allergy Asthma Immunol 2020; 125:581-588. [PMID: 32711031 PMCID: PMC7375272 DOI: 10.1016/j.anai.2020.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ASTHMAXcel mobile application has been linked to favorable outcomes among adult patients with asthma. OBJECTIVE To assess the impact of ASTHMAXcel Adventures, a gamified, guideline-based, pediatric version on asthma control, knowledge, health care utilization, and patient satisfaction. METHODS Pediatric patients with asthma received the ASTHMAXcel Adventures mobile intervention on-site only at baseline (visit 1), 4 months (visit 2), and 6 months (visit 3). The asthma control test, asthma illness representation scale-self-administered, pediatric asthma impact survey, and Client Satisfaction Questionnaire-8 were used to assess asthma control, knowledge, and patient satisfaction. Patients reported the number of asthma-related emergency department (ED) visits, hospitalizations, and oral prednisone use. RESULTS A total of 39 patients completed the study. The proportion of controlled asthma increased from visit 1 to visits 2 and 3 (30.8% vs 53.9%, P = .04; 30.8% vs 59.0%, P = .02), and largely seen in boys. The mean asthma illness representation scale-self-administered scores increased from baseline pre- to postintervention, with sustained improvements at visits 2 and 3 (3.55 vs 3.76, P < .001; 3.55 vs 3.80, P = .001; 3.55 vs 3.99, P < .001). The pediatric asthma impact survey scores improved from baseline to visits 2 and 3 (43.33 vs 34.08, P < .001; 43.33 vs 31.74, P < .001). ED visits and prednisone use significantly decreased from baseline to visits 2 and 3 (ED: 0.46 vs 0.13, P = .03; 0.46 vs 0.02, P = .02; prednisone use, 0.49 vs 0.13, P = .02; 0.49 vs 0.03, P = .003. Satisfaction was high with mean client satisfaction questionnaire score of approximately 30 (out of 32) at all visits. CONCLUSION ASTHMAXcel Adventures improved asthma control, knowledge, and quality of life, and reduced ED visits and prednisone use with high satisfaction scores.
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Affiliation(s)
- Brian C Hsia
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Anjani K Singh
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Obumneme Njeze
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Emine Cosar
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Wenzhu B Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jonathan Feldman
- Division of Academic General Pediatrics, Department of Pediatrics, the Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York; Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Marina Reznik
- Division of Academic General Pediatrics, Department of Pediatrics, the Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Sunit P Jariwala
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
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11
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Elliman MG, Sloman P, South M, Cheng DR. Action plans into action - An electronic action plan generation tool at a paediatric centre. Int J Med Inform 2020; 141:104219. [PMID: 32623329 DOI: 10.1016/j.ijmedinf.2020.104219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/24/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Individualised Action Plans (APs) are a key management tool for paediatric asthma, allergy, anaphylaxis and eczema. They provide salient care instructions for patients and caregivers and are thought to improve disease outcomes, albeit with minimal supporting evidence. Whilst the provision of an AP has become a widely measured healthcare quality marker, the content of the plans provided has been relatively neglected. The Royal Children's Hospital, Melbourne (RCH) implemented an AP generation tool integrated within its Electronic Medical Record (EMR) in 2017. This case study aims to exhibit the potential benefits of a hospital-wide integrated AP tool, assess its uptake and usage at our institution and demonstrate quality and user interface issues detected through audit of APs provided. METHODS A retrospective observational analysis of all APs created within the RCH EMR for patients aged 0-18 years between January 1 and December 31, 2018 was conducted. For each AP, automatically populated and clinician entered fields were extracted and analysed. RESULTS 2637 APs were completed during the study period. The most used AP was for asthma. Omission rates of critical information were low but could be improved. Depending on clinical condition, there was variation in both the location of completion (ED vs clinic/hospital visit) and role of clinician completing the AP (consultant vs junior medical staff). CONCLUSION There was considerable uptake of an EMR-integrated AP tool across our institution. An electronic AP allowed for qualitative evaluation of usage and audit of AP content and will guide further system and user interface improvements to improve AP quality.
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Affiliation(s)
- Mark G Elliman
- Department of General Medicine, Royal Children's Hospital, Parkville, Australia
| | - Peter Sloman
- EMR Project, Royal Children's Hospital, 50 Flemington Rd, Parkville, Australia
| | - Mike South
- Department of General Medicine, Royal Children's Hospital, Parkville, Australia; EMR Project, Royal Children's Hospital, 50 Flemington Rd, Parkville, Australia; Department of Paediatrics, University of Melbourne, Carlton, Australia; Murdoch Children's Research Institute, Parkville, Australia
| | - Daryl R Cheng
- Department of General Medicine, Royal Children's Hospital, Parkville, Australia; EMR Project, Royal Children's Hospital, 50 Flemington Rd, Parkville, Australia; Department of Paediatrics, University of Melbourne, Carlton, Australia; Murdoch Children's Research Institute, Parkville, Australia.
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12
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Hsia B, Mowrey W, Keskin T, Wu S, Aita R, Kwak L, Ferastraoarou D, Rosenstreich D, Jariwala SP. Developing and pilot testing ASTHMAXcel, a mobile app for adults with asthma. J Asthma 2020; 58:834-847. [PMID: 32046564 DOI: 10.1080/02770903.2020.1728770] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: We sought to compare the impact of ASTHMAXcel, a novel, guideline-based, patient-facing mobile app to human-delivered asthma education.Methods: We conducted a focus group with asthma patients in the Bronx to identify desired mobile app features. ASTHMAXcel was designed based on patient feedback and consistent with NAEPP, BTS/SIGN, and GINA guidelines. The app was reviewed by internists, allergist/immunologists, and pulmonologists specializing in asthma treatment, asthma educators, and a behavioral scientist, and iteratively refined. The refined version of ASTHMAXcel was administered once via tablet at our outpatient Montefiore Asthma Center (MAC). Asthma knowledge was measured through the Asthma Knowledge Questionnaire (AKQ) pre and post-intervention. We also recorded process outcomes including completion time and patient satisfaction. In parallel, human-delivered education was delivered once at MAC. These outcomes were similarly collected.Results: 60 patients were enrolled with 30 in the ASTHMAXcel and 30 in the human-educator group. Mean AKQ in the ASTHMAXcel group vs human-educator group pre-intervention was 9.9 vs 10.5, p = 0.27. Mean AKQ post-intervention in the ASTHMAXcel group vs human-educator group was 12.3 vs 14.4, p = 0.0002. The mean AKQ improvement for both groups were 2.4 vs 3.9, p = 0.007. Patients were highly satisfied in the ASTHMAXcel group scoring on average 27.9 out of 30 maximum points on the satisfaction survey. There was no difference in satisfaction scores or completion times (minutes) of either intervention.Conclusion: ASTHMAXcel was associated with an increase in AKQ, but the human-educator group experienced a greater improvement. ASTHMAXcel demonstrated no differences in process outcomes vs human-delivered education.
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Affiliation(s)
- Brian Hsia
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Wenzhu Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Taha Keskin
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Sammy Wu
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Rohit Aita
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Lily Kwak
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Denisa Ferastraoarou
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - David Rosenstreich
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Sunit P Jariwala
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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13
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Gupta S, Price C, Agarwal G, Chan D, Goel S, Boulet LP, Kaplan AG, Lebovic G, Mamdani M, Straus SE. The Electronic Asthma Management System (eAMS) improves primary care asthma management. Eur Respir J 2019; 53:13993003.02241-2018. [PMID: 30765503 PMCID: PMC6482383 DOI: 10.1183/13993003.02241-2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/23/2019] [Indexed: 12/28/2022]
Abstract
A high prevalence of suboptimal asthma control is attributable to known evidence–practice gaps. We developed a computerised clinical decision support system (the Electronic Asthma Management System (eAMS)) to address major care gaps and sought to measure its impact on care in adults with asthma. This was a 2-year interrupted time-series study of usual care (year 1) versus eAMS (year 2) at three Canadian primary care sites. We included asthma patients aged ≥16 years receiving an asthma medication within the last 12 months. The eAMS consisted of a touch tablet patient questionnaire completed in the waiting room, with real-time data processing producing electronic medical record-integrated clinician decision support. Action plan delivery (primary outcome) improved from zero out of 412 (0%) to 79 out of 443 (17.8%) eligible patients (absolute increase 0.18 (95% CI 0.14–0.22)). Time-series analysis indicated a 30.5% increase in physician visits with action plan delivery with the intervention (p<0.0001). Assessment of asthma control level increased from 173 out of 3497 (4.9%) to 849 out of 3062 (27.7%) eligible visits (adjusted OR 8.62 (95% CI 5.14–12.45)). Clinicians escalated controller therapy in 108 out of 3422 (3.2%) baseline visits versus 126 out of 3240 (3.9%) intervention visits (p=0.12). At baseline, a short-acting β-agonist alone was added in 62 visits and a controller added in 54 visits; with the intervention, this occurred in 33 and 229 visits, respectively (p<0.001). The eAMS improved asthma quality of care in real-world primary care settings. Strategies to further increase clinician uptake and a randomised controlled trial to assess impact on patient outcomes are now required. The Electronic Asthma Management System is a systematically developed and evidence-based computerised decision support tool that engages both patients and healthcare providers to improve the quality of asthma care in real-world primary care settingshttp://ow.ly/w43Z30nxALB
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Affiliation(s)
- Samir Gupta
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada .,Division of Respirology, Dept of Medicine, University of Toronto, Toronto, ON, Canada
| | - Courtney Price
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Gina Agarwal
- Dept of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - David Chan
- Dept of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sanjeev Goel
- Health Quality Innovation Collaborative, Brampton, ON, Canada
| | - Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Universite Laval, Québec, QC, Canada
| | - Alan G Kaplan
- Family Physician Airways Group of Canada, Edmonton, AB, Canada.,Respiratory Medicine Special Interest Focus Group, College of Family Physicians of Canada, Mississauga, ON, Canada
| | - Gerald Lebovic
- Applied Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training (LKS-CHART), Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Sharon E Straus
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
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14
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Kouri A, Kaplan A, Boulet LP, Gupta S. New evidence-based tool to guide the creation of asthma action plans for adults. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:103-106. [PMID: 30765356 PMCID: PMC6515492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To improve the use of asthma action plans (AAPs) among primary care physicians. SOURCES OF INFORMATION In a 2017 article, recent asthma guidelines and adult studies (January 2010 to March 2016) addressing acute loss of asthma control were reviewed to develop an evidence-based tool to help guide physicians in creating AAPs to maximize adherence and minimize errors. Evidence supporting the effects of AAPs is level I. Evidence supporting the recommendations in the tool ranges from level I to consensus. MAIN MESSAGE A lack of knowledge about and training in creating appropriate AAP content is an important barrier to the use of AAPs, as is the fact that instructions provided by asthma guidelines are often difficult to integrate into real-world practice. In order to address these issues, a freely accessible, practical, evidence-based tool has recently been created, addressing both the knowledge and the practical barriers to AAP creation. This tool has been formatted as a printable bedside chart for the point of care, but could also be integrated into a computerized electronic decision support system in the future. CONCLUSION Asthma action plans, in conjunction with asthma education and regular follow-up, can improve patients' symptoms and quality of life and reduce hospitalization. This novel point-of-care tool provides practical advice on how to complete AAPs to improve patients' asthma self-management.
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Affiliation(s)
- Andrew Kouri
- Clinical fellow in the Division of Respirology in the Department of Medicine at the University of Toronto in Ontario.
| | - Alan Kaplan
- Chair of the Board of Directors for the Family Physician Airways Group of Canada and Clinical Lecturer in the Department of Family and Community Medicine at the University of Toronto
| | - Louis-Philippe Boulet
- Respirologist in the Institut universitaire de cardiologie et de pneumologie de Québec of Laval University in Quebec city, Que
| | - Samir Gupta
- Associate Scientist with the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital in Toronto
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15
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Kouri A, Kaplan A, Boulet LP, Gupta S. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:e51-e55. [PMID: 30765369 PMCID: PMC6515485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objectif Améliorer l’utilisation des plans d’action pour l’asthme (PAA) par les omnipraticiens. Sources de l’information Un article publié en 2017 passait en revue les récentes lignes directrices de prise en charge de l’asthme et les études menées auprès d’adultes (de janvier 2010 à mars 2016) portant sur la perte aiguë de la maîtrise de l’asthme, dans le but de créer un outil factuel pouvant orienter les médecins dans la création de PAA de manière à optimiser l’observance du traitement et à réduire les erreurs au minimum. Les données probantes étayant les effets des PAA sont de niveau I. Les données probantes étayant les recommandations faites dans l’outil varient entre le niveau I et le consensus. Message principal Un obstacle important à l’emploi des PAA est l’absence de connaissances des PAA et de formation pour créer un contenu approprié, de même que la difficulté d’intégrer dans la pratique réelle les instructions fournies dans les lignes directrices sur l’asthme. Pour faire tomber ces obstacles, un outil factuel, pratique et facilement accessible a récemment vu le jour; il aborde les obstacles pratiques et liés aux connaissances en matière de création d’un PAA. Cet outil prend la forme d’un tableau à imprimer pouvant être utilisé au chevet du patient, mais il pourra aussi à l’avenir être intégré dans un système informatisé d’aide à la décision. Conclusion Les plans d’action pour l’asthme, jumelés à l’éducation sur l’asthme et au suivi régulier, soulagent les symptômes, améliorent la qualité de vie et réduisent les hospitalisations. Ce nouvel outil de point de service fournit des conseils pratiques sur la façon de créer un PAA dans le but d’améliorer l’autoprise en charge de l’asthme.
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Affiliation(s)
- Andrew Kouri
- Boursier clinique à la Division de pneumologie au Département de médecine de l'Université de Toronto, en Ontario.
| | - Alan Kaplan
- Président du conseil d'administration du Regroupement canadien des médecins de famille en santé respiratoire et chargé d'enseignement clinique au Département de médecine familiale et communautaire de l'Université de Toronto, en Ontario
| | - Louis-Philippe Boulet
- Pneumologue à l'Institut universitaire de cardiologie et de pneumologie de Québec de l'Université Laval à Québec, au Québec
| | - Samir Gupta
- Scientifique adjoint au Keenan Research Centre de l'institut Li Ka Shing Knowledge Institute de l'Hôpital St Michael's à Toronto
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Asthma action plans in the adult population: Rediscovering an invaluable tool in today's health care domain. J Am Assoc Nurse Pract 2019; 30:262-269. [PMID: 29757842 DOI: 10.1097/jxx.0000000000000055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND PURPOSE Asthma in adults remains a leading cause of morbidity, mortality, and increased health care costs. Asthma action plans (AAPs) have demonstrated improved health outcomes in this populace; however, AAPs continue to be underused by providers. This article aims to re-emphasize the importance of AAPs for adults and refresh providers on the effectiveness and methods to use this indispensable tool. METHODS A literature search of MEDLINE, PubMed, Google Scholar, and CINAHL was performed, and subsequent findings were reported. CONCLUSIONS With proper involvement and inclusion of the patient in the creation of an AAP, adult patients can greatly improve their self-management capabilities through its use. IMPLICATIONS FOR PRACTICE By recognizing the importance and success of AAPs for adults, providers can improve their personal practice through increased AAP delivery. Understanding today's available platforms and formats for AAPs will allow providers a widened subject knowledge base and increased adaptation of patient AAP needs for the adult population. Increased provider knowledge can potentially increase AAP use for adults, as well as improve overall patient outcomes.
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17
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Colborn KL, Helmkamp L, Bender BG, Kwan BM, Schilling LM, Sills MR. Colorado Asthma Toolkit Implementation Improves Some Process Measures of Asthma Care. J Am Board Fam Med 2019; 32:37-49. [PMID: 30610140 PMCID: PMC6943943 DOI: 10.3122/jabfm.2019.01.180155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/30/2018] [Accepted: 10/02/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Colorado Asthma Toolkit Program (CATP) has been shown to improve processes of care with less evidence demonstrating improved outcomes. OBJECTIVE To model the association between pre-and-post-CATP status and asthma-related process and outcome measures among patients ages 5 to 64 years receiving care in safety-net primary care practices. METHODS This is an implementation study involving secondary prepost analysis of existing structured clinical, administrative, and claims data. Nine primary care practices in a federally qualified health center network implemented the CATP. Processes of care and health and utilization outcomes were evaluated prepost implementation in a cohort of patients with asthma using generalized linear mixed models. RESULTS The study cohort included 2678 patients age 5 to 64 years with at least one visit to one of the 9 participating practices during the study period (March 12, 2010 to December 1, 2012). A comparison of 12 months pre- and post-CATP implementation showed improvement in some process measures of asthma care associated with the intervention, including the rate of asthma-severity measurement, although no change in 2 Health care Effectiveness Data and Information Set measures: asthma medication ratio and medication management for people with asthma. We also found no change in asthma outcomes measured across multiple domains: exacerbations, utilization, symptom scores, and pulmonary physiology measures. CONCLUSIONS Implementation of the CATP in a primary care setting led to some improved processes of asthma care, but no changes in measured outcomes. Recommendations for future work include supplemental follow-up training including case review.
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Affiliation(s)
- Kathryn L Colborn
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS).
| | - Laura Helmkamp
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Bruce G Bender
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Bethany M Kwan
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Lisa M Schilling
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Marion R Sills
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
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McCleary N, Andrews A, Buelo A, Captieux M, Morrow S, Wiener-Ogilvie S, Fletcher M, Steed L, Taylor SJC, Pinnock H. IMP 2ART systematic review of education for healthcare professionals implementing supported self-management for asthma. NPJ Prim Care Respir Med 2018; 28:42. [PMID: 30401831 PMCID: PMC6219611 DOI: 10.1038/s41533-018-0108-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/29/2018] [Accepted: 09/11/2018] [Indexed: 12/22/2022] Open
Abstract
Despite a robust evidence base for its effectiveness, implementation of supported self-management for asthma is suboptimal. Professional education is an implementation strategy with proven effectiveness, though the specific features linked with effectiveness are often unclear. We performed a systematic review of randomised controlled trials and controlled clinical trials (published from 1990 and updated to May 2017 using forward citation searching) to determine the effectiveness of professional education on asthma self-management support and identify features of effective initiatives. Primary outcomes reflected professional behaviour change (provision of asthma action plans) and patient outcomes (asthma control; unscheduled care). Data were coded using the Effective Practice and Organisation of Care Taxonomy, the Theoretical Domains Framework (TDF), and Bloom's Taxonomy and synthesised narratively. Of 15,637 articles identified, 18 (reporting 15 studies including 21 educational initiatives) met inclusion criteria. Risk of bias was high for five studies, and unclear for 10. Three of 6 initiatives improved action plan provision; 1/2 improved asthma control; and 2/7 reduced unscheduled care. Compared to ineffective initiatives, effective initiatives were more often coded as being guideline-based; involving local opinion leaders; including inter-professional education; and addressing the TDF domains 'social influences'; 'environmental context and resources'; 'behavioural regulation'; 'beliefs about consequences'; and 'social/professional role and identity'. Findings should be interpreted cautiously as many strategies were specified infrequently. However, identified features warrant further investigation as part of implementation strategies aiming to improve the provision of supported self-management for asthma.
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Affiliation(s)
- Nicola McCleary
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Audrey Buelo
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Mireille Captieux
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Susan Morrow
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Monica Fletcher
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Liz Steed
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie J C Taylor
- Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
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Poureslami I, Shum J, Lester RT, Tavakoli H, Dorscheid DR, FitzGerald JM. A pilot randomized controlled trial on the impact of text messaging check-ins and a web-based asthma action plan versus a written action plan on asthma exacerbations. J Asthma 2018; 56:1-13. [PMID: 30003851 DOI: 10.1080/02770903.2018.1500583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/16/2018] [Accepted: 07/09/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE We compared electronic asthma action plans (eAAP) supported by automated text messaging service (SMS) with written asthma action plans (AAP) on assessing acceptability and asthma control improvement. We hypothesized that the patients in eAAP group would have more improvements in their quality of life, asthma control and decreased asthma exacerbations. METHODS Patients with physician-diagnosed asthma having at least one asthma exacerbation in the previous 12 months were recruited. Participants received individualized action plans and were randomly assigned into either the intervention (eAAP) or control (AAP) group. Intervention participants received weekly SMS, triggering assessment of asthma control and viewing their eAAP. We assessed applicability of Telehealth platform on asthma exacerbations, asthma control, and quality of life over a 12-month period. RESULTS 106 patients were enrolled (eAAP = 52, AAP = 54). The cumulative response rate to all weekly SMS check-ins was 68.4%. Overall, 28% of patients checked into their eAAP during the intervention period. There were fewer exacerbations in the eAAP group (18%) compared to the AAP group (RR = 0.82 [95%CI 0.49, 1.36]), (P = 0.44). The mean scores for asthma control and quality of life were higher in the eAAP group compared to the AAP group by 4% (RR = 1.04 [95%CI 0.83, 1.30]), (P = 0.73) and 5.5% (RR = 1.06 [95%CI 0.87, 1.28]), (P = 0.59), respectively, but were not statistically significant. CONCLUSIONS We demonstrated that the eAAP presented improved asthma control outcomes, but as expected the sample size was inadequate to show a significant difference, but based on this pilot study we plan a larger appropriately powered randomized controlled trial (RCT).
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Affiliation(s)
- Iraj Poureslami
- a Division of Respiratory Medicine, Department of Medicine , Institute for Heart and Lung Health, The University of British Columbia , Vancouver , Canada
- b Centre for Clinical Epidemiology and Evaluation , Vancouver Coastal Health Research Institute, The University of British Columbia , Vancouver , Canada
| | - Jessica Shum
- a Division of Respiratory Medicine, Department of Medicine , Institute for Heart and Lung Health, The University of British Columbia , Vancouver , Canada
- b Centre for Clinical Epidemiology and Evaluation , Vancouver Coastal Health Research Institute, The University of British Columbia , Vancouver , Canada
| | - Richard T Lester
- c Division of Infectious Diseases, Department of Medicine , The University of British Columbia , Vancouver , Canada
| | - Hamid Tavakoli
- d Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences , The University of British Columbia , Vancouver , Canada
| | - Delbert R Dorscheid
- e Centre for Heart Lung Innovation, St. Paul's Hospital , The University of British Columbia , Vancouver , Canada
| | - J Mark FitzGerald
- a Division of Respiratory Medicine, Department of Medicine , Institute for Heart and Lung Health, The University of British Columbia , Vancouver , Canada
- b Centre for Clinical Epidemiology and Evaluation , Vancouver Coastal Health Research Institute, The University of British Columbia , Vancouver , Canada
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Gupta S, Lam Shin Cheung V, Kastner M, Straus S, Kaplan A, Boulet LP, Sale JEM. Patient preferences for a touch screen tablet-based asthma questionnaire. J Asthma 2018; 56:771-781. [PMID: 29972087 DOI: 10.1080/02770903.2018.1490750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Assessment of asthma control and provision of asthma action plans are seldom performed in practice, partly due to limited time for physicians to ascertain required information. A patient-facing electronic asthma questionnaire could facilitate information collection. We sought to design a touch-tablet asthma questionnaire for use in the clinic waiting room and to describe patient preferences for the content of such a questionnaire. METHODS We created a questionnaire prototype based on best evidence and employed rapid-cycle design (semi-structured focus group testing; analysis; corresponding modifications and re-testing) with asthma patients aged ≥16 years. We analyzed transcripts using deductive and inductive content analysis. Quantitative measures included Likert-scale questions and questionnaire completion times. RESULTS There were 20 participants across five focus groups (15/20 (75%) female, age 49.1 ± 15.6 years). Content-related themes included: 1) comprehensibility (language) (how questionnaire language affected ease and accuracy of comprehension) and b) information collection (issues arising during information collection in the following identified subthemes: personal asthma symptoms and triggers; asthma control; asthma medications and contact information). Average questionnaire completion time was 11.7 ± 5.9 min. Summative Likert scale responses suggested high levels of question comprehension and confidence with responses. CONCLUSIONS Our analysis provides novel insight about how best to formulate and present asthma-related content in an electronic questionnaire. Such questionnaires might facilitate quality improvement by improving efficiency of data collection, enabling better assessment of asthma control and medication adherence, and personalization of asthma action plans. Future studies should measure real-world uptake of such a questionnaire and impact on care.
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Affiliation(s)
- Samir Gupta
- a Li Ka Shing Knowledge Institute of St. Michael's Hospital , Toronto , Canada.,b Department of Medicine , University of Toronto , Toronto , Canada.,c Department of Medicine, Division of Respirology , St. Michael's Hospital , Toronto , Canada
| | | | - Monika Kastner
- d Department of Research and Innovation , North York General Hospital , Toronto , Canada
| | - Sharon Straus
- a Li Ka Shing Knowledge Institute of St. Michael's Hospital , Toronto , Canada.,b Department of Medicine , University of Toronto , Toronto , Canada
| | - Alan Kaplan
- e Department of Family and Community Medicine, University of Toronto , Toronto , Canada.,f Family Physician Airways Group of Canada , Edmonton , Canada
| | - Louis-Philippe Boulet
- g Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval , Québec, Canada
| | - Joanna E M Sale
- h Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.,i Musculoskeletal Health and Outcomes Research , Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada
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Gupta S, Kaplan A. Solving the mystery of the yellow zone of the asthma action plan. NPJ Prim Care Respir Med 2018; 28:1. [PMID: 29323120 PMCID: PMC5765154 DOI: 10.1038/s41533-017-0067-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/07/2017] [Accepted: 11/23/2017] [Indexed: 12/04/2022] Open
Affiliation(s)
- Samir Gupta
- Department of Medicine, Division of Respirology, University of Toronto, Toronto, Canada. .,The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
| | - Alan Kaplan
- University of Toronto, Toronto, Canada.,Family Physician Airways Group of Canada, Edmonton, Canada
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Pinnock H, Sheikh A. Standards for reporting implementation studies (StaRI): enhancing reporting to improve care. NPJ Prim Care Respir Med 2017; 27:42. [PMID: 28652602 PMCID: PMC5484688 DOI: 10.1038/s41533-017-0045-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/20/2017] [Accepted: 05/31/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, EH* 9AG, UK.
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, EH* 9AG, UK
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