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Price D, Jenkins C, Hancock K, Vella R, Heraud F, Le Cheng P, Murray R, Beekman M, Bosnic-Anticevich S, Botini F, Carter V, Catanzariti A, Doan J, Fletton K, Kichkin A, Le T, Le Lievre C, Lau CM, Novic D, Pakos J, Ranasinghe K, Roussos A, Samuel-King J, Sharma A, Stewart D, Willet B, Bateman E. The Association Between Short-Acting β 2-Agonist Over-Prescription, and Patient-Reported Acquisition and Use on Asthma Control and Exacerbations: Data from Australia. Adv Ther 2024; 41:1262-1283. [PMID: 38310584 PMCID: PMC10879376 DOI: 10.1007/s12325-023-02746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/20/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION In Australia, short-acting β2-agonists (SABA) are available both over the counter (OTC) and on prescription. This ease of access may impact SABA use in the Australian population. Our aim was to assess patterns and outcome associations of prescribed, acquired OTC and reported use of SABA by Australians with asthma. METHODS This was a cross-sectional study, using data derived from primary care electronic medical records (EMRs) and patient completed questionnaires within Optimum Patient Care Research Database Australia (OPCRDA). A total of 720 individuals aged ≥ 12 years with an asthma diagnosis in their EMRs and receiving asthma therapy were included. The annual number of SABA inhalers authorised on prescription, acquired OTC and reported, and the association with self-reported exacerbations and asthma control were investigated. RESULTS 92.9% (n = 380/409) of individuals issued with SABA prescription were authorised ≥ 3 inhalers annually, although this differed from self-reported usage. Of individuals reporting SABA use (n = 546) in the last 12 months, 37.0% reported using ≥ 3 inhalers. These patients who reported SABA overuse experienced 2.52 (95% confidence interval [CI] 1.73-3.70) times more severe exacerbations and were 4.51 times (95% CI 3.13-6.55) more likely to have poor asthma control than those who reported using 1-2 SABA inhalers. Patients who did not receive SABA on prescription (43.2%; n = 311/720) also experienced 2.71 (95% CI 1.07-7.26) times more severe exacerbations than those prescribed 1-2 inhalers. Of these patients, 38.9% reported using OTC SABA and other prescription medications, 26.4% reported using SABA OTC as their only asthma medication, 13.2% were prescribed other therapies but not SABA OTC and 14.5% were not using any medication. CONCLUSION Both self-reported SABA overuse and zero SABA prescriptions were associated with poor asthma outcomes. The disconnect between prescribing authorisation, OTC availability and actual use, make it difficult for clinicians to quantify SABA use.
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Affiliation(s)
- David Price
- Optimum Patient Care, 5 Coles Lane, Oakington, CB24 3BA, Cambridgeshire, UK.
- Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06-76, Midview City, 573969, Singapore.
- Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
- Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia.
| | - Christine Jenkins
- Thoracic Physician Concord Hospital, Head Respiratory Trials, George Institute, University of Sydney, Sydney, Australia
| | - Kerry Hancock
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, VIC, 3010, Australia
- RACGP Resp Medicine SIG, 100 Wellington Parade, East Melbourne, Melbourne, VIC, 3002, Australia
| | - Rebecca Vella
- Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia
| | | | - Porsche Le Cheng
- Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia
| | - Ruth Murray
- Optimum Patient Care, 5 Coles Lane, Oakington, CB24 3BA, Cambridgeshire, UK
| | - Maarten Beekman
- BioPharmaceuticals Medical and Regional Medical Director for International, The Hague, The Netherlands
| | - Sinthia Bosnic-Anticevich
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, MSW, 2037, Australia
| | - Fabio Botini
- Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia
| | - Victoria Carter
- Optimum Patient Care, 5 Coles Lane, Oakington, CB24 3BA, Cambridgeshire, UK
| | - Angelina Catanzariti
- AstraZeneca Biopharmaceuticals Medical, Medical Affairs, 66 Talavera Road, Macquarie Park, NSW, Australia
| | - Joe Doan
- HealthPlus Medical Centre, 28/26 Belgrave St, Kogarah, NSW, 2217, Australia
| | - Kirsty Fletton
- Optimum Patient Care, 5 Coles Lane, Oakington, CB24 3BA, Cambridgeshire, UK
| | - Ata Kichkin
- Blue Shield Family General Practice, Kogarah, NSW, 2217, Australia
| | - Thao Le
- Medical Education, and Events Management Pte Ltd, Singapore, Singapore
| | - Chantal Le Lievre
- Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia
| | - Chi Ming Lau
- Toukley Family Practice, 37-41 Canton Beach Road, Toukley, NSW, 2263, Australia
| | - Dominique Novic
- Redlands Medical Centre, 189 Vienna Rd, Alexandra Hills, 4161, Australia
| | - John Pakos
- Woodcroft Medical Centre, Woodcroft, SA, 5162, Australia
| | - Kanchanamala Ranasinghe
- School of Medicine, Griffith University, Gold Coast, Australia
- Cannon Hill Family Doctors, 17/1177 Wynnum Rd, Cannon Hill, QLD, 4170, Australia
| | - Alexander Roussos
- Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia
| | | | - Anita Sharma
- Platinum Medical Centre, 18 Banfield St, Chermside, QLD, 4032, Australia
| | - Deb Stewart
- School of Medicine, University of Tasmania, Churchill Ave, Hobart, TAS, 7005, Australia
| | - Bruce Willet
- Victoria Point Surgery, Brisbane, QLD, 4165, Australia
| | - Eric Bateman
- Department of Medicine, University of Cape Town, and University Cape Town Lung Institute, Cape Town, South Africa
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Schwartz A, Beemer LR, Ajibewa TA, Scott-Andrews KQ, Lewis TC, Robinson LE, Hasson RE. An exploratory analysis examining differences in physical activity and motor competence in children with and without asthma: brief report. J Asthma 2023; 60:2153-2159. [PMID: 37339004 DOI: 10.1080/02770903.2023.2225606] [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: 11/22/2022] [Revised: 05/12/2023] [Accepted: 06/11/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE The purpose of this pilot study was to examine potential differences in motor competence (MC) and physical activity (PA) between children with and without asthma. METHODS Thirty-seven children and adolescents completed the Exercises for a Healthy Asthma Lifestyle and Enjoyment study (46% with asthma, 51% female, 11.1 ± 0.4 years, and 46% White). Motor competence was assessed using the Movement Assessment Battery for Children 2nd edition (MABC-2). PA was assessed using accelerometry. RESULTS Children with asthma had significantly lower MC in the domain of aiming and catching (with asthma: 8.2 ± 0.4 vs. without asthma: 9.9 ± 0.5; p = 0.03) and fewer daily minutes spent in moderate-to-vigorous PA (MVPA) (with asthma: 18.0 ± 2.3 min vs. without asthma: 27.2 ± 3.6 min; p = 0.047). There were no significant group differences in manual dexterity, balance, total MABC-2 score, or total daily PA (all ps > 0.05). CONCLUSIONS This study provides confirmatory evidence that children with asthma display lower MC and spend less time in MVPA compared to children without asthma. Because MC is a prerequisite for engaging in PA, future research should seek to determine if the differences observed in MC contribute to disparities in MVPA observed in this clinical population.
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Affiliation(s)
- Anna Schwartz
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Lexie R Beemer
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Toby C Lewis
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Leah E Robinson
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca E Hasson
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Forbes R, Clasper B, Ilango A, Kan H, Peng J, Mandrusiak A. Effectiveness of patient education training on health professional student performance: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:2453-2466. [PMID: 33678497 DOI: 10.1016/j.pec.2021.02.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/01/2021] [Accepted: 02/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite the fundamental role of patient education, concerns have been raised by health professionals, students, and professional bodies regarding student preparation for this area of practice. OBJECTIVE To evaluate the effectiveness of patient education training on health professional student performance. METHOD A systematic search was performed across PubMed, Cinahl, Embase, and Cochrane Library. Reference and forward citation searches of included articles were conducted. Inclusion criteria were published journal articles from 2010 to 2020 regarding patient education training for health professional students with measures relating to patient education performance. Quality appraisal of individual studies was conducted using Cochrane risk-of-bias v2 or ROBINS-I; overall appraisal was also determined. Sixteen articles met eligibility criteria. Independent data extraction was undertaken. RESULTS Fourteen studies reported improvements in student performance following patient education training; two studies reported no significant improvements. Of different modalities examined, simulation-based learning appeared to be most effective. CONCLUSION Patient education training enhances health professional students' performance of patient education. Future research is needed to evaluate effectiveness of pedagogically informed interventions across health professions using objective approaches to assess student performance in clinically relevant settings. PRACTICAL VALUE This review supports the use of specific training approaches to improve student performance of patient education.
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Affiliation(s)
- Roma Forbes
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Bennita Clasper
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Anusha Ilango
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Haeley Kan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Julia Peng
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
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Zartab S, Nikfar S, Karimpour-Fard N, Jamshidi A, Varahrami V, Homayouni A, Kebriaeezadeh A. A Systematic Review of Discrete Choice Experiment Studies in Rheumatoid Arthritis Biological Medicines. Mediterr J Rheumatol 2021; 32:104-111. [PMID: 34447905 PMCID: PMC8369269 DOI: 10.31138/mjr.32.2.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/29/2020] [Accepted: 02/05/2021] [Indexed: 01/20/2023] Open
Abstract
Objective: Rheumatoid arthritis is a chronic disease with various clinical characteristics. The introduction of biological drugs has enhanced the efficacy and increased diversity of treatment options. Considering the patients’ preferences in decision-making about treatment can improve their adherence. A discrete choice experiment is a type of conjoint method that can elicit preferences in more realistic scenarios. This article reviewed discrete choice experiment (DCE) studies to extract which attributes and levels were included in surveys. In addition, we focused on the process of designing surveys and the method that they used. Method: PubMed, EMBASE, Web of Science, Scopus, Ovid (Medline) and ProQuest were systematically searched in order to find studies that evaluated rheumatoid arthritis patients’ preferences about biological medicines. Studies published in peer-reviewed journals between 1/1/1990 and 12/31/2019 were included. The included studies were analyzed using a narrative synthesis method and descriptive statistics. Results: A total of 7124 studies were initially found. After deleting irrelevant and duplicate studies, 15 studies were included. The most common attributes that were used in surveys were efficacy, adverse effect, route of administration, frequency of administration, and cost. Most studies used a literature review for developing attributes and levels. The median number of included attributes and levels were seven and three, respectively. Eight studies explained their experimental design while seven studies did not. Conditional logit and mixed logit were the most common methods for modeling reciprocally. Conclusion: Several aspects of DCE studies investigating biological drugs in RA were assessed. Explaining the sample size, experimental design, and qualitative work for developing attributes can improve this type of study.
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Affiliation(s)
- Saman Zartab
- Pharmaceutical Management & Economic Research Center and Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Pharmaceutical Management & Economic Research Center and Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Naeim Karimpour-Fard
- Pharmaceutical Management & Economic Research Center and Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Jamshidi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vida Varahrami
- Department of Economics, School of Economics and Political Sciences, Shahid Beheshti University, Tehran, Iran
| | - Ali Homayouni
- Pharmaceutical Management & Economic Research Center and Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Pharmaceutical Management & Economic Research Center and Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Badawy SM, Shah R, Beg U, Heneghan MB. Habit Strength, Medication Adherence, and Habit-Based Mobile Health Interventions Across Chronic Medical Conditions: Systematic Review. J Med Internet Res 2020; 22:e17883. [PMID: 32343250 PMCID: PMC7218590 DOI: 10.2196/17883] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/02/2020] [Accepted: 03/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Unintentional medication nonadherence is common and has been associated with poor health outcomes and increased health care costs. Earlier research demonstrated a relationship between habit strength and medication adherence. Previous research also examined a habit's direct effect on adherence and how habit interacts with more conscious factors to influence or overrule them. However, the relationship between habit and adherence and the role of habit-based mobile health (mHealth) interventions remain unclear. OBJECTIVE This review aimed to systematically evaluate the most recent evidence for habit strength, medication adherence, and habit-based mHealth interventions across chronic medical conditions. METHODS A keyword search with combinations of the terms habit, habit strength, habit index, medication adherence, and medication compliance was conducted on the PubMed database. After duplicates were removed, two authors conducted independent abstract and full-text screening. The guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed when reporting evidence across the included and reviewed studies. RESULTS Of the 687 records examined, 11 met the predefined inclusion criteria and were finalized for data extraction, grading, and synthesis. Most included studies (6/11, 55%) were cross-sectional and used a theoretical model (8/11, 73%). The majority of studies measured habit strength using the self-report habit index and self-report behavioral automaticity index (9/11, 82%). Habit strength was positively correlated with medication adherence in most studies (10/11, 91%). Habit mediated the effects of self-efficacy on medication adherence (1/11, 9%), and social norms moderated the effects of habit strength on medication adherence (1/11, 9%). Habit strength also moderated the effects of poor mental health symptoms and medication adherence (1/11, 9%). None of the included studies reported on using or proposing a habit-based mHealth behavioral intervention to promote medication adherence. CONCLUSIONS Habit strength was strongly correlated with medication adherence, and stronger habit was associated with higher medication adherence rates, regardless of the theoretical model and/or guiding framework. Habit-based interventions should be used to increase medication adherence, and these interventions could leverage widely available mobile technology tools such as mobile apps or text messaging, and existing routines.
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Affiliation(s)
- Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Richa Shah
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Usman Beg
- Midwestern University Arizona College of Osteopathic Medicine, Glendale, AZ, United States
| | - Mallorie B Heneghan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Gebremariam TH, Sherman CB, Schluger NW. Perception of asthma control among asthmatics seen inChest Clinic at Tertiary Hospital, Addis Ababa, Ethiopia. BMC Pulm Med 2019; 19:187. [PMID: 31660922 PMCID: PMC6819349 DOI: 10.1186/s12890-019-0959-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/15/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patient awareness of asthma severity is important for optimal asthma management. However, there is often a discrepancy between physician assessment of asthma control based on guidelines and patient discernment of control. We compared physician and patient perception of asthma control in a clinic population seen at a tertiary hospital in Addis Ababa, Ethiopia. METHODS In this cross-sectional study, 182 consecutive patients with a physician diagnosis of asthma seen in Chest Clinic at Tikur Anbessa Specialized Hospital (TASH) between July and December 2015 were studied. Demographics, asthma symptoms, medication use in the past month, and self-perception of asthma control in the past 7 days were obtained from the clinic records. Physician assessed asthma control was based on the GINA asthma symptom control assessment tool. Lung function was measured using a Diagnostic EasyOne Plus model 2001 SN spirometer. The institutional review board approved the study protocol. RESULTS Of the 182 subjects, 68.1% were female. The mean age was 52 ± 12 years, and the mean (SD) duration of asthma was 19.4 ± 12.7 years. Forty-four (24.2%) patients had physician determined well-controlled asthma and 138 (75.8%) patients had physician determined partly controlled/uncontrolled asthma. One hundred and fifty-one (83%) patients thought their asthma control was good. However, the degree of concordance between physician evaluation and patient perception of asthma control was low (kappa index = 0.09). On multivariate analysis, self-perceived poor asthma control was associated with any activity limitation due to asthma and inconsistent inhaled corticosteroid use. CONCLUSION In our study, the first of its kind in Ethiopia, a high percent of patients with physician determined well-controlled asthma has appropriate perception of their disease state. However, those patients with partly controlled/uncontrolled asthma had poor self-perception of their disease, emphasizing the need for further patient education. These conclusions may be especially useful in the care of asthmatics from other low-income countries.
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Affiliation(s)
- Tewodros H. Gebremariam
- Addis Ababa University, College of Heath Sciences, Lideta Sub-city Gambia St., P O Box 22787 code, 1000 Addis Ababa, Ethiopia
| | | | - Neil W. Schluger
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia, USA
- University College of Physicians and Surgeons, New York, NY USA
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Khdour MR, Elyan SO, Hallak HO, Jarab AS, Mukattash TL, Astal A. Assessment of the inhalation technique and adherence to therapy and their effect on disease control in outpatients with asthma. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maher R. Khdour
- Faculty of Pharmacy; Al-Quds University; Jerusalem Palestine
| | - Sabrin O. Elyan
- The Department of Pharmacy at Makassed Hospital; Jerusalem Palestine
| | | | - Anan S. Jarab
- Faculty of Pharmacy; Department of Clinical Pharmacy; Jordan University of Science & Technology; Irbid Jordan
| | - Tareq L. Mukattash
- Faculty of Pharmacy; Department of Clinical Pharmacy; Jordan University of Science & Technology; Irbid Jordan
| | - Amr Astal
- The Department of Internal Medicine at Makassed Hospital; Jerusalem Palestine
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Understanding the Impact of Paediatric Asthma on Families: Development of a Theoretical Model. BEHAVIOUR CHANGE 2018. [DOI: 10.1017/bec.2018.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The experience of paediatric asthma is associated with increased stress and emotional difficulties for both the child and family. The current study aimed to qualitatively explore parents’ views of their child's asthma experience, from initial diagnosis onwards, to enhance our understanding of how families emotionally adjust and adapt to the diagnosis and management of asthma. Semi-structured interviews were conducted with 17 parents of children (<18 years) with physician-diagnosed asthma. Questionnaires were used to capture demographic information and anxiety symptom status of parents (State Trait Anxiety Inventory — Form Y [STAI-Y1/Y2]) and children (Spence Children's Anxiety Scale — Parent reported [SCAS-P]). Grounded theory was used to analyse the results. Analysis saw three themes emerge as important in understanding the impact of asthma on the family: (1) the experience of obtaining an asthma diagnosis, (2) parents’ belief in their competence to manage asthma, and (3) parents’ behaviour in response to the asthma. A model was developed that posits adaptive parental adjustment to asthma is determined in part by the circumstances around the time of diagnosis, the level of knowledge and skills, and the controllability of the asthma. This model can guide medical and allied health professionals to specific areas where intervention may reduce stress and emotional difficulties associated with asthma and its management for affected families.
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Britto MT, Rohan JM, Dodds CM, Byczkowski TL. A Randomized Trial of User-Controlled Text Messaging to Improve Asthma Outcomes: A Pilot Study. Clin Pediatr (Phila) 2017; 56:1336-1344. [PMID: 28056541 DOI: 10.1177/0009922816684857] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We enrolled 64 patients age 12 to 22 years with a diagnosis of poorly controlled persistent asthma in a 6-month longitudinal crossover study. During the 3 intervention months, participants created personalized text messages to be sent to their phones. Adherence was objectively monitored in 22 of the participants. The adolescent participants gave high ratings on the acceptability of the text messaging system. Asthma control improved from baseline to month 1 regardless of whether teens were in the texting or control group. While participants were in the texting group, their quality of life improved and worry about their asthma decreased. Receiving the text intervention resulted in an increase in adherence of 2.75% each month relative to no intervention, but the improvements were not sustained. There was modest improvement in asthma control and quality of life outcomes, as well as improved adherence during the texting intervention.
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Affiliation(s)
- Maria T Britto
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer M Rohan
- 2 Boston Children's Hospital, Boston, MA, USA.,3 Harvard Medical School, Boston, MA, USA
| | - Cassandra M Dodds
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Winn CON, Mackintosh KA, Eddolls WTB, Stratton G, Wilson AM, Rance JY, Doull IJM, McNarry MA, Davies GA. Perceptions of asthma and exercise in adolescents with and without asthma. J Asthma 2017; 55:868-876. [DOI: 10.1080/02770903.2017.1369992] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- C. O. N. Winn
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
- Applied Sports Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, Wales, UK
| | - K. A. Mackintosh
- Applied Sports Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, Wales, UK
| | - W. T. B. Eddolls
- Applied Sports Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, Wales, UK
| | - G. Stratton
- Applied Sports Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, Wales, UK
| | - A. M. Wilson
- Norwich Medical School, University of East Anglia, Norwich, England, UK
| | - J. Y. Rance
- College of Human and Health Sciences, Swansea University, Swansea, Wales, UK
| | - I. J. M. Doull
- Department of Paediatric Respiratory Medicine and Paediatric Cystic Fibrosis Centre, Children's Hospital for Wales, Cardiff, Wales, UK
| | - M. A. McNarry
- Applied Sports Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, Wales, UK
| | - G. A. Davies
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
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Eliasson L, de Freitas HM, Dearden L, Calimlim B, Lloyd AJ. Patients' Preferences for the Treatment of Metastatic Castrate-resistant Prostate Cancer: A Discrete Choice Experiment. Clin Ther 2017; 39:723-737. [PMID: 28366592 DOI: 10.1016/j.clinthera.2017.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE Patient treatment preferences are increasingly being used to inform health care decision making. This discrete choice experiment assessed how men perceive the risks and benefits of hypothetical treatment options for metastatic castrate-resistant prostate cancer (mCRPC). METHODS Treatment attributes for inclusion were identified through a review of the literature and product labels. Expert interviews confirmed clinical appropriateness and patient relevance of the attributes, which included effectiveness (delay in months before chemotherapy), steroid use, possible drug interactions (additional hospital visits for monitoring), fogginess (effects on cognition and memory), fatigue (extreme tiredness), food restrictions, and bone pain. Following a pilot, the final discrete choice experiment included 18 choice sets presenting treatments for mCRPC and was completed by men with mCRPC in France, Germany, and the United Kingdom. Data were analyzed using a conditional logit model, with odds ratios (ORs) used to indicate preference for attributes, and tradeoff measures (TOM) were estimated using the ratio of coefficients. FINDINGS Within each attribute category and with all other factors being equal, participants (N = 285) indicated a strong preference for treatments that fully control bone pain (OR = 12.069 [95% CI, 10.555-13.800]) and for treatments that delay chemotherapy (OR, 1.727 [95% CI, 1.548-1.927]). They also preferred treatments that were associated with the lowest risk of fogginess (OR, 2.115 [95% CI, 1.849-2.420]), a lower risk of fatigue (OR, 1.365 [95% CI 1.219-1.528]), and fewer additional hospital visits (OR, 1.245 [95% CI 1.111-1.397]) than the respective reference categories. Participants preferred to use steroids under advice from a physician (OR, 1.275 [95% CI 1.132-1.437]). Food restrictions related to taking medication were not a significant concern for participants. TOM results indicated that large tradeoffs in effectiveness, fogginess, and fatigue are required for patients to prefer a treatment with uncontrolled bone pain that is very difficult to live with. IMPLICATIONS Men with mCRPC consider a wide range of factors when making decisions regarding their treatment. They showed a strong preference for treatment associated with better control of bone pain. They also placed value on treatments that could delay the need for chemotherapy, and they preferred to avoid side effects such as cognition and memory loss, and extreme tiredness. TOMs highlighted the importance of symptom control, even compared with potential side effects. An understanding of the degree to which patients value the attributes associated with various treatment options will assist clinicians and health care professionals when making decisions regarding the management of men with mCRPC.
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Affiliation(s)
- Lina Eliasson
- Clinical Outcomes Assessment, ICON Clinical Research Plc, UK.
| | | | | | - Brian Calimlim
- Medical Affairs Statistical Analysis, ICON plc, San Francisco, California
| | - Andrew J Lloyd
- Clinical Outcomes Assessment, ICON Clinical Research Plc, UK
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Murray J, Williams B, Hoskins G, Skar S, McGhee J, Treweek S, Sniehotta FF, Sheikh A, Brown G, Hagen S, Cameron L, Jones C, Gauld D. A theory-informed approach to developing visually mediated interventions to change behaviour using an asthma and physical activity intervention exemplar. Pilot Feasibility Stud 2016; 2:46. [PMID: 27965863 PMCID: PMC5154090 DOI: 10.1186/s40814-016-0091-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/30/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Visualisation techniques are used in a range of healthcare interventions. However, these frequently lack a coherent rationale or clear theoretical basis. This lack of definition and explicit targeting of the underlying mechanisms may impede the success of and evaluation of the intervention. We describe the theoretical development, deployment, and pilot evaluation, of a complex visually mediated behavioural intervention. The exemplar intervention focused on increasing physical activity among young people with asthma. We employed an explicit five-stage development model, which was actively supported by a consultative user group. The developmental stages involved establishing the theoretical basis, establishing a narrative structure, visual rendering, checking interpretation, and pilot testing. We conducted in-depth interviews and focus groups during early development and checking, followed by an online experiment for pilot testing. A total of 91 individuals, including young people with asthma, parents, teachers, and health professionals, were involved in development and testing. RESULTS Our final intervention consisted of two components: (1) an interactive 3D computer animation to create intentions and (2) an action plan and volitional help sheet to promote the translation of intentions to behaviour. Theory was mediated throughout by visual and audio forms. The intervention was regarded as highly acceptable, engaging, and meaningful by all stakeholders. The perceived impact on asthma understanding and intentions was reported positively, with most individuals saying that the 3D computer animation had either clarified a range of issues or made them more real. Our five-stage model underpinned by extensive consultation worked well and is presented as a framework to support explicit decision-making for others developing theory informed visually mediated interventions. CONCLUSIONS We have demonstrated the ability to develop theory-based visually mediated behavioural interventions. However, attention needs to be paid to the potential ambiguity associated with images and thus the concept of visual literacy among patients. Our revised model may be helpful as a guide to aid development, acceptability, and ultimately effectiveness.
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Affiliation(s)
- Jennifer Murray
- Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN UK
| | - Brian Williams
- Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN UK
| | - Gaylor Hoskins
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, Stirling Innovation Park, Stirling, FK9 4NF Scotland
| | - Silje Skar
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, Stirling Innovation Park, Stirling, FK9 4NF Scotland
| | - John McGhee
- 3D Visualisation Aesthetics Lab, Art & Design University of New South Wales, Sydney, Australia
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD Scotland
| | - Falko F. Sniehotta
- Institute of Health & Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX England
- Fuse, the UK CRC Centre of Excellence for Translational Research in Public Health, NewCastle, UK
| | - Aziz Sheikh
- Volunteer Centre Borders, First Floor, Riverside House, Ladhope Vale, Galashiels, TD1 1BT Scotland
| | - Gordon Brown
- Asthma UK Scotland, Hayweight House, 4th Floor, 23 Lauriston Street, Edinburgh, EH3 9DQ Scotland
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Linda Cameron
- University of California, Merced, 5200 N. Lake Road, Merced, CA 95343 USA
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Dundee, DD1 4HN Scotland
| | - Dylan Gauld
- Duncan of Jordanstone College of Art and Design, University of Dundee, Dundee, Scotland
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Lisicki R, Chu L. What Matters to Patients and Physicians When Considering Biologic Therapy for Rheumatoid Arthritis. Postgrad Med 2015; 120:154-60. [DOI: 10.3810/pgm.2008.09.1915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Augustovski F, Beratarrechea A, Irazola V, Rubinstein F, Tesolin P, Gonzalez J, Lencina V, Scolnik M, Waimann C, Navarta D, Citera G, Soriano ER. Patient preferences for biologic agents in rheumatoid arthritis: a discrete-choice experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:385-393. [PMID: 23538191 DOI: 10.1016/j.jval.2012.11.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 11/05/2012] [Accepted: 11/26/2012] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To assess patients' preferences for rheumatoid-arthritis treatments with biologic agents using a discrete-choice experiment. METHODS A discrete-choice experiment was conducted with adult rheumatoid-arthritis patients who had never been treated with biological agents from two university hospitals-public and private-in Buenos Aires, Argentina. We evaluated preferences for seven treatment attributes (with two to three levels each): effectiveness, mode of administration, frequency of administration, local and systemic adverse events, severe infections, and out-of-pocket costs.A probit regression model was used to analyze the relative importance of rheumatoid-arthritis treatment attributes. We estimated attributes' relative importance and their 95% confidence intervals. RESULTS Survey responses from 240 patients with rheumatoid arthritis receiving conventional disease-modifying antirheumatic drugs were included in the study. All tested biological agents' attributes significantly affected the choice of treatment. Attributes' relative importance in decreasing order was the following (mean, confidence interval 95%): cost, 0.81 (0.69-0.92); systemic adverse events, 0.66 (0.57-0.76); frequency of administration, 0.61 (0.52-0.71); efficacy, 0.42 (0.32-0.51); route of administration, 0.41 (0.30-0.52); local adverse events, 0.40 (0.31-0.49); and serious infections, 0.29 (0.22-0.37). CONCLUSIONS Different treatment attributes had a significant and different influence in rheumatoid-arthritis patients' choice of biological agents. This type of study can not only inform about patients' preferences but also about the trade-offs among different possible treatments or process-related attributes.
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Affiliation(s)
- Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
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Britto MT, Munafo JK, Schoettker PJ, Vockell ALB, Wimberg JA, Yi MS. Pilot and feasibility test of adolescent-controlled text messaging reminders. Clin Pediatr (Phila) 2012; 51:114-21. [PMID: 22019792 DOI: 10.1177/0009922811412950] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This pilot study assessed the feasibility, acceptability, and utility of a text messaging system that allowed teenagers with asthma to generate and control medical reminders sent to their mobile phones. METHODS The 12 teens in the study group were able to create their own reminder text messages, add or change reminders, and determine when and how often the messages were sent to their cell phone. RESULTS In total, 18 of the 21 unique messages created were reminders to take medication. No teen made changes to their original text messages or delivery schedule on their own. They gave high ratings on the usefulness, acceptability, and ease of use of the text messaging system. Self-reported asthma control at baseline was similar for both the study and comparison groups and did not change significantly. CONCLUSIONS Allowing teens to control the timing and content of reminder text messages may support self-management of chronic disease.
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Affiliation(s)
- Maria T Britto
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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16
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Erkoçoğlu M, Akan A, Civelek E, Kan R, Azkur D, Kocabaş CN. Consistency of GINA criteria and childhood asthma control test on the determination of asthma control. Pediatr Allergy Immunol 2012; 23:34-9. [PMID: 22136557 DOI: 10.1111/j.1399-3038.2011.01232.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reliable assessment of asthma control is essential for effective treatment. Although several methods are used to assess asthma control, it is still suboptimal all over the world. Childhood asthma control test (C-ACT) is a widely used complementary test in determining the level of asthma control in conjunction with GINA guidelines. OBJECTIVE To evaluate the consistency between the childhood asthma control test (C-ACT) and the Global Initiative for Asthma (GINA) guideline-based asthma control measure in children with asthma and, if present, to investigate the reasons for any discrepancy. METHODS Patients and their caregivers filled a C-ACT and a socioeconomic status survey before the physician visit. Asthma control level was also assessed according to GINA criteria by a pediatric allergist who was blinded to C-ACT scores. RESULTS The mean age of the total 314 patients was 9.0 ± 1.9 yr, ranging between 4.3 and 11.8 yr, of whom 56.1% (n = 176) were men. Regarding the study group, 54.8% of patients were controlled according to GINA, and 51.0% of patients were controlled according to C-ACT (score ≥20). There was inconsistency between GINA and C-ACT in 26.7% (84/314) of the study group when the patients were evaluated individually (κ = 0.464). There was not any significant variable that could predict the consistency and inconsistency between these methods. CONCLUSION Consistency between GINA and C-ACT is not as to be expected. Using only one method for determining the control level of asthma does not seem to be reliable and accurate.
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Affiliation(s)
- Mustafa Erkoçoğlu
- Ankara Children's Hematology Oncology Education and Research Hospital, Department of Pediatric Allergy, Ankara, Turkey
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17
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Grover C, Armour C, Asperen PPV, Moles R, Saini B. Medication use in children with asthma: not a child size problem. J Asthma 2011; 48:1085-103. [PMID: 22013989 DOI: 10.3109/02770903.2011.624234] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma--in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children. METHODS A literature search using electronic search engines (i.e., Medline, International Pharmaceutical Abstracts (IPA), PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) and the search terms "asthma," "children," and "medicines" (and derivatives of these keywords) was conducted. RESULTS The search terms were expanded to include emergent themes arising out of search findings. Content themes relating to parents, children themselves, health-care professionals, organizational systems, and specific medications and devices were found. Within these themes, key issues included a lack of parental knowledge about asthma and asthma medications, lack of information provided to parents, parental beliefs and fears, parental behavioral problems, the high costs of medications and devices, the child's self-image, the need for more child responsibility, physician nonadherence to prescribing guidelines, "off-label" prescribing, poor understanding of teachers, lack of access to educational resources, and specific medications. CONCLUSION These key issues should be taken into account when modifying the development of educational tools. These tools should focus on targeting the children themselves, the parent/carers, the health-care professionals, and various organizational systems.
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Affiliation(s)
- Charu Grover
- Faculty of Pharmacy, University of Sydney, Camperdown Campus, Sydney, New South Wales, Australia
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18
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Koolen BB, Pijnenburg MWH, Brackel HJL, Landstra AM, van den Berg NJ, Merkus PJFM, Hop WCJ, Vaessen-Verberne AAPH. Validation of a web-based version of the asthma control test and childhood asthma control test. Pediatr Pulmonol 2011; 46:941-8. [PMID: 21462363 DOI: 10.1002/ppul.21458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 12/23/2010] [Accepted: 01/14/2011] [Indexed: 11/07/2022]
Abstract
RATIONALE Recent guidelines focus on adjusting asthma treatment to the level of asthma control. The availability of a web-based asthma control questionnaire offers the possibility to assess asthma control without the need of outpatient clinic visits. The aim of this study was to evaluate the agreement between web-based and paper-based versions of the Asthma Control Test (ACT) and Childhood Asthma Control Test (C-ACT), short-term reproducibility and satisfaction with both versions. METHODS One hundred seventy-three children with stable asthma and a normal lung function were randomized to fill in a web-based or paper-based version of the C-ACT (4-11 years) or ACT (12-18 years). According to a cross-over design, they completed the opposite version after 1 week. Reproducibility was evaluated by repeating the 2nd version (web- or paper-based) 7 days later. RESULTS Eighty-eight children filled in the C-ACT, 68 children filled in the ACT. Intraclass Correlation Coefficient (ICC) for web-based versus paper-based C-ACT was 0.81 (95% confidence interval [95% CI] 0.72-0.87). For ACT this was 0.84 (95% CI 0.76-0.90). For web-based and paper-based C-ACT the reproducibility ICC was 0.82 (95% CI 0.67-0.90) and 0.75 (95% CI 0.59-0.85), respectively. The reproducibility ICC of the ACT for web- and paper-based versions was 0.93 (95% CI 0.87-0.97) and 0.77 (95% CI 0.59-0.88), respectively. Eighty-six percent of patients preferred the web-based version. CONCLUSION The web-based version of the C-ACT and ACT is reproducible and comparable with the paper-based version in assessing asthma control. Most children and their parents prefer the web-based version.
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Affiliation(s)
- B B Koolen
- Department of Paediatrics, Amphia Hospital, Breda, The Netherlands
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Qamar N, Pappalardo AA, Arora VM, Press VG. Patient-centered care and its effect on outcomes in the treatment of asthma. Patient Relat Outcome Meas 2011; 2:81-109. [PMID: 22915970 PMCID: PMC3417925 DOI: 10.2147/prom.s12634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Indexed: 11/23/2022] Open
Abstract
Patient-centered care may be pivotal in improving health outcomes for patients with asthma. In addition to increased attention in both research and clinical forums, recent legislation also highlights the importance of patient-centered outcomes research in the Patient Protection and Affordable Care Act. However, whether patient-centered care has been shown to improve outcomes for this population is unclear. To answer this question, we performed a systematic review of the literature that aimed to define current patient-focused management issues, characterize important patient-defined outcomes in asthma control, and identify current and emerging treatments related to patient outcomes and perspectives. We used a parallel search strategy via Medline(®), Cochrane Central Register of Controlled Trials, CINAHL(®) (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO(®), complemented with a reference review of key articles that resulted in a total of 133 articles; 58 were interventions that evaluated the effect on patient-centered outcomes, and 75 were descriptive studies. The majority of intervention studies demonstrated improved patient outcomes (44; "positive" results); none showed true harm (0; "negative"); and the remainder were equivocal (14; "neutral"). Key themes emerged relating to patients' desires for asthma knowledge, preferences for tailored management plans, and simplification of treatment regimens. We also found discordance between physicians and patients regarding patients' needs, beliefs, and expectations about asthma. Although some studies show promise regarding the benefits of patient-focused care, these methods require additional study on feasibility and strategies for implementation in real world settings. Further, it is imperative that future studies must be, themselves, patient-centered (eg, pragmatic comparative effectiveness studies) and applicable to a variety of patient populations and settings. Despite the need for further research, enough evidence exists that supports incorporating a patient-centered approach to asthma management, in order to achieve improved outcomes and patient health.
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Affiliation(s)
- Nashmia Qamar
- Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA
| | - Andrea A Pappalardo
- Internal Medicine-Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA
| | - Vineet M Arora
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Valerie G Press
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
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Britto MT, Byczkowski TL, Hesse EA, Munafo JK, Vockell ALB, Yi MS. Overestimation of impairment-related asthma control by adolescents. J Pediatr 2011; 158:1028-1030.e1. [PMID: 21392791 DOI: 10.1016/j.jpeds.2011.01.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 01/12/2011] [Accepted: 01/19/2011] [Indexed: 11/16/2022]
Abstract
We investigated the concordance between adolescents' perceived and impairment-related asthma control. Based on self-reported medication use, symptoms, and activity limitations, most overestimated their impairment-related control (73.8%). Providers should ask detailed, structured questions to get the most comprehensive picture of a patient's impairment-related control so they can ultimately improve disease outcomes.
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Affiliation(s)
- Maria T Britto
- Center for Innovation in Chronic Disease Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Shah S, Toelle BG, Sawyer SM, Roydhouse JK, Edwards P, Usherwood T, Jenkins CR. Feasibility study of a communication and education asthma intervention for general practitioners in Australia. Aust J Prim Health 2011; 16:75-80. [PMID: 21133302 DOI: 10.1071/py09056] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor-patient communication. The impact ofthe modified PACE Australia program on the processes and outcomes ofGP care ofchildren with asthma is now being measured in a randomised controlled trial.
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Affiliation(s)
- Smita Shah
- Primary Health Care Education and Research Unit, Primary and Community Health Network, Sydney West Area Health Service, Sydney, NSW 2145, Australia.
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Low exercise among children with asthma: a culture of over protection? A qualitative study of experiences and beliefs. Br J Gen Pract 2010; 60:e319-26. [PMID: 20822682 DOI: 10.3399/bjgp10x515070] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Research shows that children are insufficiently active in most affluent societies. Although children with asthma may particularly benefit from physical activity, they are less active than their peers. AIM To explore the reasons for low physical activity levels among children with asthma and to identify strategies to improve activity. DESIGN OF STUDY A qualitative study using in-depth interviews and focus groups. SETTING Six GP practices, a Paediatric Respiratory Unit, and four schools in Tayside, Scotland. METHOD Purposive sampling identified 30 children with asthma, their parents (n = 38) and school staff (n = 28), who were interviewed or took part in focus groups. Data were examined using constant comparative analysis. RESULTS The lower level of activity among children with asthma was supported by a climate of fear among parents and teachers about what was safe and possible for the child. Restrictions were imposed because of perceived dangers of exercising in the presence of 'triggers'. Physical activity was regarded as a threat to be managed rather than something beneficial. Teachers found it difficult to distinguish between children who were physically incapable of exercise due to asthma and those who were unmotivated. GPs were unknowingly drawn into the controversy by children and parents who cite medical advice to sanction exemption from exercise. CONCLUSION GPs and asthma nurses need to provide clear management plans explaining what is appropriate and safe in terms of exercise on a child-by-child basis, to counter the considerable misunderstanding and disagreement among children, parents, and teachers.
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A cross-sectional survey of participation of asthmatic children in physical activity. World J Pediatr 2010; 6:238-43. [PMID: 20706822 DOI: 10.1007/s12519-010-0222-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Physical exercise has been proven to be beneficial to children with asthma, but the traditional view in China is that asthmatic children should not take part in sports. This study was undertaken to investigate the current status of children with asthma taking part in exercise in China. METHODS One hundred and twenty-three asthmatic children (7-14 years old) who had visited our asthma control center between February 2009 and June 2009 were enrolled in this cross-sectional study. Each child had a pulmonary function test and his/her health-related quality of life was assessed. The children also finished a questionnaire about their physical activity. As a control group, 109 nonasthmatic children from a primary school were surveyed about their level of activity. RESULTS Asthmatic children took part in less exercise than their healthy peers, and 62.6% (77/123) of the children with asthma never reached the criteria of exercise prescription for patients with asthma advised by the American College of Sports Medicine. The asthmatic children were divided into two groups based on the level of activity; compared with the group with a higher physical activity level, more children in the group with lower activity believed that exercise could make asthma worse, more parents and teachers restricted the children's exercise, and fewer doctors approved them participating in exercise. All of the parameters of basic lung function were higher in the group with higher activity level. Moreover, the children with a higher exercise level had a higher score on all parts of the pediatric asthma quality-of-life questionnaire. About 78.5% (96/123) of children ever experienced coughing, chest distress, dyspnea, or gasping during exercise, but 49.6% (61/123) had these symptoms occasionally. CONCLUSIONS Our study reveals that children with asthma do not have enough exercise in China. The concept that children, parents, teachers and doctors have about exercise for patients with asthma is urgent to be updated. We need to prescribe appropriate exercise for children with asthma.
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Bolman C, Arwert TG, Völlink T. Adherence to prophylactic asthma medication: habit strength and cognitions. Heart Lung 2010; 40:63-75. [PMID: 20561874 DOI: 10.1016/j.hrtlng.2010.02.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 01/20/2010] [Accepted: 02/09/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explain adherence to prophylactic asthma medication (PAM, inhaled corticosteroids) by the attitude, social influence, and self-efficacy (ASE) model added with the concept of habit strength and to study whether habit moderates or mediates relationships between ASE factors and adherence. METHODS A mail-out survey was conducted among 139 asthmatic adults. Multiple regression analysis was conducted, with self-reported adherence as the outcome and ASE factors and habit as the independent variables. Simple slope analyses and bootstrapping mediation analyses were also conducted. RESULTS Having more severe asthma, taking PAM habitually, and perceiving few negative consequences of taking PAM were associated with better adherence. Self-efficacy influenced adherence indirectly through habit. The relationship between social norms and adherence was moderated by habit: In the case of weak habits, a supportive norm in a patient's environment toward taking PAM was positively related to PAM adherence; in the case of strong habits, a supportive norm led to less adherence. CONCLUSION Interventions to increase adherence should enhance the formation of habits by stimulating patients to perform the behavior frequently in similar situations by increasing self-efficacy and providing environmental cues, such as reminder devices and pill organizers. In addition, the disadvantages of PAM use should be negated.
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Affiliation(s)
- Catherine Bolman
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands.
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25
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Ross CJM, Williams BA, Low G, Vethanayagam D. Perceptions about self-management among people with severe asthma. J Asthma 2010; 47:330-6. [PMID: 20394519 DOI: 10.3109/02770901003611462] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The purpose of this study was to explore the perceptions about self-management among people who were being followed up in a severe asthma clinic by asthma specialists for confirmed, overall severe asthma. Such insight informs how best to tailor programs for this difficult to treat patient population. METHOD In-depth tape-recorded interviews of eight adults with severe asthma were transcribed and analyzed for salient themes using content analysis. RESULTS To self-manage their illness, over time participants sought asthma information from a variety of sources that they often viewed as inadequate due to lack of scope and or plain language. The most valued sources of asthma information were encountered after referral to an asthma specialist and were health professionals and a pulmonary rehabilitation program. CONCLUSION There is a need to examine the content of asthma information sources for their relevance to and influence on the behavior of patients with severe asthma.
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Fraenkel L, Fried TR. Individualized medical decision making: necessary, achievable, but not yet attainable. ACTA ACUST UNITED AC 2010; 170:566-9. [PMID: 20308644 DOI: 10.1001/archinternmed.2010.8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The need is urgent to provide older persons with individualized information about the benefits and harms of different diagnostic and treatment strategies. This need results from the growing recognition of the heterogeneity in outcomes in older persons with differing comorbidity profiles. The heterogeneity of benefits and harms resulting from treatment is not yet as well appreciated. Warfarin vs aspirin therapy for the reduction of stroke risk in nonvalvular atrial fibrillation provides an example of a treatment for which the benefit-to-harm ratio may actually reverse according to an older person's comorbidities, thus highlighting the importance of basing this treatment decision on individualized outcome data. Despite the wealth of studies in nonvalvular atrial fibrillation, many assumptions are necessary to calculate patient-specific outcomes, and these assumptions may lead to substantial overestimation or underestimation of benefits and harms. Improving care for patients with comorbidities will require substantive increases in the efforts and resources allocated to the collection and dissemination of outcome data for patients with varying comorbidities.
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Affiliation(s)
- Liana Fraenkel
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
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Fereday J, MacDougall C, Spizzo M, Darbyshire P, Schiller W. "There's nothing I can't do--I just put my mind to anything and I can do it": a qualitative analysis of how children with chronic disease and their parents account for and manage physical activity. BMC Pediatr 2009; 9:1. [PMID: 19117528 PMCID: PMC2636806 DOI: 10.1186/1471-2431-9-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Accepted: 01/01/2009] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This paper reports the findings of a South Australian qualitative, exploratory study of children and young people living with a chronic disease, and their perceptions and experiences of physical activity. The perceptions and experiences of their parents were also explored. The chronic diseases were type 1 diabetes, asthma and cystic fibrosis. METHODS Multiple qualitative data collection techniques were used to elicit the children and young people's perspectives and experiences of physical activity, including focus groups, maps, photos and 'traffic light posters'. The children's parents were interviewed separately to ascertain their views of their child's participation in physical activities. RESULTS Children and young people described their active participation in a wide variety of physical activities including organised sports and play, but made very little mention of any negative influence or impact due to their disease. Their parents' stories described the diligent background planning and management undertaken to enable their child to participate in a wide range of physical activities. CONCLUSION The results of this study suggest that for these children and young people, having a chronic disease was not perceived as a barrier to participation in organised sport and recreational activities. They were physically active and perceived themselves to be no different from their peers. Their positive beliefs were shared by their parents and the level of participation described was enabled by the high level of parental support and background planning involved in managing their child's health care needs.
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Affiliation(s)
- Jennifer Fereday
- Children, Youth and Women's Health Service, 72 King William St, North Adelaide, South Australia, Australia
| | - Colin MacDougall
- Department of Public Health, School of Medicine, Flinders University, GPO Box 2100, Adelaide, South Australia, Australia
| | - Marianne Spizzo
- Children, Youth and Women's Health Service, 72 King William St, North Adelaide, South Australia, Australia
| | - Philip Darbyshire
- Children, Youth and Women's Health Service, University of South Australia and Flinders University, South Australia, Australia
| | - Wendy Schiller
- Division of Education, Arts and Social Sciences, University of South Australia GPO Box 2471, Adelaide, South Australia, Australia
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Basheti IA, Armour CL, Bosnic-Anticevich SZ, Reddel HK. Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique. PATIENT EDUCATION AND COUNSELING 2008; 72:26-33. [PMID: 18314294 DOI: 10.1016/j.pec.2008.01.014] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 01/05/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate the feasibility, acceptability and effectiveness of a brief intervention about inhaler technique, delivered by community pharmacists to asthma patients. METHODS Thirty-one pharmacists received brief workshop education (Active: n=16, CONTROL: n=15). Active Group pharmacists were trained to assess and teach dry powder inhaler technique, using patient-centered educational tools including novel Inhaler Technique Labels. Interventions were delivered to patients at four visits over 6 months. RESULTS At baseline, patients (Active: 53, CONTROL: 44) demonstrated poor inhaler technique (mean+/-S.D. score out of 9, 5.7+/-1.6). At 6 months, improvement in inhaler technique score was significantly greater in Active cf. CONTROL patients (2.8+/-1.6 cf. 0.9+/-1.4, p<0.001), and asthma severity was significantly improved (p=0.015). Qualitative responses from patients and pharmacists indicated a high level of satisfaction with the intervention and educational tools, both for their effectiveness and for their impact on the patient-pharmacist relationship. CONCLUSION A simple feasible intervention in community pharmacies, incorporating daily reminders via Inhaler Technique Labels on inhalers, can lead to improvement in inhaler technique and asthma outcomes. PRACTICE IMPLICATIONS Brief training modules and simple educational tools, such as Inhaler Technique Labels, can provide a low-cost and sustainable way of changing patient behavior in asthma, using community pharmacists as educators.
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Williams B, Powell A, Hoskins G, Neville R. Exploring and explaining low participation in physical activity among children and young people with asthma: a review. BMC FAMILY PRACTICE 2008; 9:40. [PMID: 18590558 PMCID: PMC2447841 DOI: 10.1186/1471-2296-9-40] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 06/30/2008] [Indexed: 11/10/2022]
Abstract
Background Asthma is the most common chronic illness among children and accounts for 1 in 5 of all child GP consultations. This paper reviews and discusses recent literature outlining the growing problem of physical inactivity among young people with asthma and explores the psychosocial dimensions that may explain inactivity levels and potentially relevant interventions and strategies, and the principles that should underpin them. Methods A narrative review based on an extensive and documented search of search of CinAHL, Embase, Medline, PsycINFO and the Cochrane Library. Results & Discussion Children and young people with asthma are generally less active than their non-asthmatic peers. Reduced participation may be influenced by organisational policies, family illness beliefs and behaviours, health care advice, and inaccurate symptom perception and attribution. Schools can be reluctant to encourage children to take part in physical education or normal play activity due to misunderstanding and a lack of clear corporate guidance. Families may accept a child's low level of activity if it is perceived that breathlessness or the need to take extra inhalers is harmful. Many young people themselves appear to accept sub-optimal control of symptoms and frequently misinterpret healthy shortness of breath on exercising with the symptoms of an impending asthma attack. Conclusion A multi-faceted approach is needed to translate the rhetoric of increasing activity levels in young people to the reality of improved fitness. Physical activity leading to improved fitness should become part of a goal orientated management strategy by schools, families, health care professionals and individuals. Exercise induced asthma should be regarded as a marker of poor control and a need to increase fitness rather as an excuse for inactivity. Individuals' perceptual accuracy deserves further research attention.
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Affiliation(s)
- Brian Williams
- Social Dimensions of Health Institute, University of Dundee, Dundee, UK.
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Smith S, Mitchell C, Bowler S. Patient-centered education: applying learner-centered concepts to asthma education. J Asthma 2008; 44:799-804. [PMID: 18097853 DOI: 10.1080/02770900701645256] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To review studies of patient-centered asthma education. METHOD CINAHL, Medline, Psycinfo, Eric, PsycARTICLES, and web of science databases were searched. RESULTS Asthma education programs are often based on health behavior theories. Many studies lack rigor in the assessment of the program's efficacy and effectiveness. Asthma education that promotes self-management primarily uses a problem-based approach. Few studies have examined the way educators teach and patients learn. Patient-centered approaches to education have mainly focused on communication between the patient and the health professional. Decision making as part of shared responsibility may vary with every patient. Patient-centered care shares similarities with the Self-Determination Theory as a learner-centered approach to education. CONCLUSIONS Many asthma education studies have been completed with varying levels of efficacy and effectiveness reported. Most programs focus on changing behavior with few studies examining educator behavior and/or the patient's learning styles. With a patient-centered approach being the preferred model of care, the incorporation of learner-centered approaches to patient education may prove useful in the future.
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Affiliation(s)
- Sheree Smith
- Centre for Evidence-Based Medicine, Department of Primary Health Care, University of Oxford, Oxford, United Kingdom.
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Key barriers to optimal management of adult asthma in Australia: physician and patient perspectives. Curr Med Res Opin 2007; 23:1799-807. [PMID: 17597555 DOI: 10.1185/030079907x210714] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Despite recent advances in asthma treatment, its management in many patients remains sub-optimal. The aim of the Global Asthma Physicians and Patient (GAPP) survey was to identify barriers to optimal asthma management and to explore the content and dynamics of physician-patient communications. Here we present the key findings for adults with asthma in Australia. RESEARCH DESIGN AND METHODS Patients with asthma aged > or = 18 years and physicians who treat adults (generalists; specialists) participated in telephone interviews conducted in May-June 2005, using close-end questionnaires. The survey examined physicians' beliefs and prescribing habits; patients' experiences with asthma; doctor-patient communication; satisfaction with asthma medications and interest in new asthma treatment. RESULTS A total of 101 adults with asthma and 100 physicians treating asthma patients in Australia completed the survey. Overall, key barriers to optimal asthma management included medication side effects, treatment compliance and patient education. These barriers may be exacerbated by poor patient-physician communication that fails to address patients concerns regarding side effects and may lead to poor treatment compliance. Both physicians and patients expressed safety concerns regarding the long-term use of inhaled corticosteroid and both groups would welcome new treatment options with improved safety profiles, efficacy and once-daily dosing. CONCLUSION From both a physician and patient perspective, the safety profile of asthma medication constitutes a key factor in promoting treatment compliance and, ultimately, treatment outcomes. The results highlight discrepancies in perceived patient-physician communication and a need for improved patient education in asthma management.
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McGhan SL, Cicutto LC, Befus AD. Advances in development and evaluation of asthma education programs. Curr Opin Pulm Med 2005; 11:61-8. [PMID: 15591890 DOI: 10.1097/01.mcp.0000146783.18716.31] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Effective asthma education requires more than merely providing information on asthma. Behavior change and learning principles must be incorporated into educational programs. However, there remains much debate and research about the most effective strategies to educate people to deal effectively with their asthma. This article focuses on recent advances in theoretical and practical strategies and examines core elements of successful asthma education programs. RECENT FINDINGS Asthma education has improved in recent years as a result of application of evidence-based, theoretical principles that guide learning and behavior modification. Many studies show a refreshing focus on how to teach and have made substantial contributions to testing educational theories and making meaningful improvements to those with asthma. Successful asthma education programs include behavior change strategies, shared care practices and communication skills, a clear educational process, tailoring to client needs and influencing factors, multiple teaching formats, and a continuum of care. SUMMARY An array of effective and innovative asthma education programs have been developed and tested. However, numerous areas in asthma education require improvement and further research, such as real-world models, sensitivities to underserved populations or venues, innovative partnerships, continuum of care, and patient incentive/participation.
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Affiliation(s)
- Shawna L McGhan
- Alberta Asthma Centre, University of Alberta, Edmonton, Alberta, Canada.
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Charrois T, Newman S, Sin D, Senthilselvan A, Tsuyuki RT. Improving asthma symptom control in rural communities: the design of the Better Respiratory Education and Asthma Treatment in Hinton and Edson study. ACTA ACUST UNITED AC 2005; 25:502-14. [PMID: 15465619 DOI: 10.1016/j.cct.2004.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Accepted: 07/29/2004] [Indexed: 11/28/2022]
Abstract
METHODS The prevalence of asthma in adults in the United States is approximately 7%, and 9% of asthma patients will require hospitalization each year. Many patients do not seek care, as they do not recognize overuse of beta-agonists as a risk factor for poorly controlled asthma. However, pharmacists are able to identify these patients through refill information on reliever medication prescriptions and potentially initiate community-management opportunities for these patients. DESIGN The study is a randomized, controlled trial. Patients are randomized to intervention or usual care. STUDY POPULATION Patients are high-risk asthma patients (defined as having an ER visit or hospitalization in the previous year, or using >2 canisters of short-acting beta-agonist in the previous 6 months). They are identified through community pharmacies. OBJECTIVES The primary objective is to determine the effect of an education and referral intervention program initiated by community pharmacists, working with high-risk asthma patients, family physicians and respiratory therapists, on asthma control, as measured by the Asthma Control Questionnaire (ACQ). Secondary objectives include determining the effect of this program on ER visits/hospitalizations, inhaled corticosteroid use, courses of oral steroids and FEV(1). INTERVENTION The intervention includes patient education, assessment and optimization of drug therapy, and physician referral as needed. Patients are referred to a respiratory therapist within 1 week of randomization for measurement of FEV(1) and reinforcement of education. Patients assigned to usual care receive written asthma information, referral to a respiratory therapist and usual pharmacy and physician care. UNIQUE ASPECTS: The design of the Better Respiratory Education and Asthma Treatment in Hinton and Edson (BREATHE) study is unique, given the multidisciplinary involvement, rural and community based, pharmacist initiated and targets specifically high risk patients. We believe that this study will show that management of asthma patients, involving the major role-players in their asthma care, will improve their asthma control.
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Affiliation(s)
- Theresa Charrois
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta T6G 2C8, Canada
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Sawyer SM, Shah S. Improving asthma outcomes in harder-to-reach populations: challenges for clinical and community interventions. Paediatr Respir Rev 2004; 5:207-13. [PMID: 15276132 DOI: 10.1016/j.prrv.2004.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The burden of asthma differs from country to country and within populations. The factors that influence this variation include asthma prevalence and severity, aspects of healthcare services (such as accessibility, quality and utilisation) and social demographic factors (such as income inequality, cultural and linguistic diversity and indigenous populations). The identification of individuals and populations that are 'harder to reach', 'special' or at greater risk of poor asthma outcomes therefore depends on how the burden of asthma and its management are measured. Meeting the challenge of educating harder-to-reach populations with asthma is the focus of this article. In clinical settings, communication is the mainstay of engaging and building trust to influence behavioural change in individuals; community-based interventions provide valuable opportunities for targeting harder-to-reach populations. However, they require active community consultation and participation and innovative approaches to service delivery, in addition to being theoretically driven and systematically developed.
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Affiliation(s)
- Susan M Sawyer
- Centre for Adolescent Health and Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.
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Fraenkel L, Bogardus ST, Concato J, Felson DT, Wittink DR. Patient preferences for treatment of rheumatoid arthritis. Ann Rheum Dis 2004; 63:1372-8. [PMID: 15020312 PMCID: PMC1754807 DOI: 10.1136/ard.2003.019422] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To elicit treatment preferences of patients with rheumatoid arthritis (RA) for disease modifying antirheumatic drugs (DMARDs) with varying risk profiles. METHODS Patient values for 16 DMARD characteristics were ascertained using published data about side effects, effectiveness, and cost. Patient preferences were determined by Adaptive Conjoint Analysis, an interactive computer program that predicts preferences by asking patients to make trade-offs between specific treatment characteristics. Simulations were run to derive preferences for four drugs: methotrexate, gold, leflunomide, and etanercept, under different risk-benefit scenarios. Infliximab was not included because it is given with methotrexate, and we did not include preferences for combination therapy. Based on each patient's expressed preferences, and the characteristics of the treatments available at the time of the study, the option that best fitted each patient's perspective was identified. RESULTS 120 patients (mean age 70 years) were interviewed. For the base case scenario (which assumed the maximum benefits reported in the literature, a low probability of adverse effects, and low equal monthly "co-pays" (out of pocket costs)), 95% of the respondents preferred etanercept over the other treatment options. When all four options were described as being equally effective, 88% continued to prefer etanercept owing to its safer short term adverse effect profile. Increasing etanercept's co-pay to $30.00 decreased the percentage of patients preferring this option to 80%. CONCLUSIONS In this study, older patients with RA, when asked to consider trade-offs between specific risk and benefits, preferred etanercept over other treatment options. Preference for etanercept is explained by older patients' risk aversion for drug toxicity.
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Affiliation(s)
- L Fraenkel
- VA Connecticut Healthcare System, West Haven, CT 06516, USA.
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