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Huebschmann AG, Wagner NM, Gleason M, Brinton JT, Brtnikova M, Brewer SE, Begum A, Armstrong R, DeCamp LR, McFarlane A, DeKeyser H, Coleman H, Federico MJ, Szefler SJ, Cicutto LC. Reducing asthma attacks in disadvantaged school children with asthma: study protocol for a type 2 hybrid implementation-effectiveness trial (Better Asthma Control for Kids, BACK). Implement Sci 2024; 19:60. [PMID: 39148094 PMCID: PMC11325631 DOI: 10.1186/s13012-024-01387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Asthma is a leading cause of children's hospitalizations, emergency department visits, and missed school days. Our school-based asthma intervention has reduced asthma exacerbations for children experiencing health disparities in the Denver Metropolitan Area, due partly to addressing care coordination for asthma and social determinants of health (SDOH), such as access to healthcare and medications. Limited dissemination of school-based asthma programs has occurred in other metropolitan and rural areas of Colorado. We formed and engaged community advisory boards in socioeconomically diverse regions of Colorado to develop two implementation strategy packages for delivering our school-based asthma intervention - now termed "Better Asthma Control for Kids (BACK)" - with tailoring to regional priorities, needs and resources. METHODS In this proposed type 2 hybrid implementation-effectiveness trial, where the primary goal is equitable reach to families to reduce asthma disparities, we will compare two different packages of implementation strategies to deliver BACK across four Colorado regions. The two implementation packages to be compared are: 1) standard set of implementation strategies including Tailor and Adapt to context, Facilitation and Training termed, BACK-Standard (BACK-S); 2) BACK-S plus an enhanced implementation strategy, that incorporates network weaving with community partners and consumer engagement with school families, termed BACK-Enhanced (BACK-E). Our evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, including its Pragmatic Robust Implementation Sustainability Model (PRISM) determinants of implementation outcomes. Our central hypothesis is that our BACK-E implementation strategy will have significantly greater reach to eligible children/families than BACK-S (primary outcome) and that both BACK-E and BACK-S groups will have significantly reduced asthma exacerbation rates ("attacks") and improved asthma control as compared to usual care. DISCUSSION We expect both the BACK-S and BACK-E strategy packages will accelerate dissemination of our BACK program across the state - the comparative impact of BACK-S vs. BACK-E on reach and other RE-AIM outcomes may inform strategy selection for scaling BACK and other effective school-based programs to address chronic illness disparities. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT06003569, registered on August 22, 2023, https://classic. CLINICALTRIALS gov/ct2/show/NCT06003569 .
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Affiliation(s)
- Amy G Huebschmann
- Anschutz Medical Campus Department of Medicine, Division of General Internal Medicine, University of Colorado, 12631 E. 17th Ave., Mailstop B180, Aurora, CO, USA.
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA.
- Ludeman Family Center for Women's Health Research, Aurora, CO, USA.
| | - Nicole M Wagner
- Anschutz Medical Campus Department of Medicine, Division of General Internal Medicine, University of Colorado, 12631 E. 17th Ave., Mailstop B180, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
| | - Melanie Gleason
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - John T Brinton
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
| | - Michaela Brtnikova
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
| | - Sarah E Brewer
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anowara Begum
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
| | - Rachel Armstrong
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
| | - Lisa Ross DeCamp
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
| | - Arthur McFarlane
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - Heather DeKeyser
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), 1890 Revere Ct, Suite P32-3200, Mailstop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - Holly Coleman
- Trailhead Institute, 1999 Broadway Suite 200, Denver, CO, 80202, USA
| | - Monica J Federico
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - Stanley J Szefler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA, CO
- Breathing Institute, Children's Hospital Colorado, 13123 East 16Th Avenue, Mailstop B395, Aurora, CO, 80045, USA
| | - Lisa C Cicutto
- National Jewish Health and University of Colorado College of Nursing and Clinical Sciences, Aurora, CO, USA
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Smith LB, O'Brien C, Kenney GM, Waidmann TA. Black-White Disparities in Asthma Hospitalizations and ED Visits Among Medicaid-Enrolled Children. Hosp Pediatr 2024; 14:490-498. [PMID: 38752291 DOI: 10.1542/hpeds.2023-007477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Asthma is a common, potentially serious childhood chronic condition that disproportionately afflicts Black children. Hospitalizations and emergency department (ED) visits for asthma can often be prevented. Nearly half of children with asthma are covered by Medicaid, which should facilitate access to care to manage and treat symptoms. We provide new evidence on racial disparities in asthma hospitalizations and ED visits among Medicaid-enrolled children. METHODS We used comprehensive Medicaid claims data from the Transformed Medicaid Statistical Information System. Our study population included 279 985 Medicaid-enrolled children with diagnosed asthma. We identified asthma hospitalizations and ED visits occurring in 2019. We estimated differences in the odds of asthma hospitalizations and ED visits for non-Hispanic Black versus non-Hispanic white children, adjusting for sex, age, Medicaid eligibility group, Medicaid plan type, state, and rurality. RESULTS In 2019, among Black children with asthma, 1.2% had an asthma hospitalization and 8.0% had an asthma ED visit compared with 0.5% and 3.4% of white children with a hospitalization and ED visit, respectively. After adjusting for other characteristics, the rates for Black children were more than twice the rates for white children (hospitalization adjusted odds ratio 2.45, 95% confidence interval 2.23-2.69; ED adjusted odds ratio 2.42; 95% confidence interval 2.33-2.51). CONCLUSIONS There are stark racial disparities in asthma hospitalizations and ED visits among Medicaid-enrolled children with asthma. To diminish these disparities, it will be important to implement solutions that address poor quality care, discriminatory treatment in health care settings, and the structural factors that disproportionately expose Black children to asthma triggers and access barriers.
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Sarikloglou E, Fouzas S, Paraskakis E. Prediction of Asthma Exacerbations in Children. J Pers Med 2023; 14:20. [PMID: 38248721 PMCID: PMC10820562 DOI: 10.3390/jpm14010020] [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: 11/26/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Asthma exacerbations are common in asthmatic children, even among those with good disease control. Asthma attacks result in the children and their parents missing school and work days; limit the patient's social and physical activities; and lead to emergency department visits, hospital admissions, or even fatal events. Thus, the prompt identification of asthmatic children at risk for exacerbation is crucial, as it may allow for proactive measures that could prevent these episodes. Children prone to asthma exacerbation are a heterogeneous group; various demographic factors such as younger age, ethnic group, low family income, clinical parameters (history of an exacerbation in the past 12 months, poor asthma control, poor adherence to treatment, comorbidities), Th2 inflammation, and environmental exposures (pollutants, stress, viral and bacterial pathogens) determine the risk of a future exacerbation and should be carefully considered. This paper aims to review the existing evidence regarding the predictors of asthma exacerbations in children and offer practical monitoring guidance for promptly recognizing patients at risk.
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Affiliation(s)
| | - Sotirios Fouzas
- Department of Pediatrics, University of Patras Medical School, 26504 Patras, Greece;
| | - Emmanouil Paraskakis
- Paediatric Respiratory Unit, Paediatric Department, University of Crete, 71500 Heraklion, Greece
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Mansur AH, Marsh J, Bahron A, Thomas M, Walters G, Busby J, Heaney LG, Krishna MT. Difficult-to-treat asthma patients from ethnic minority groups in central England are at an enhanced risk of house dust mite sensitisation. Clin Transl Allergy 2023; 13:e12303. [PMID: 37876034 PMCID: PMC10560749 DOI: 10.1002/clt2.12303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND House dust mite (HDM) is the most common sensitising allergen in asthma. Ethnic minority groups (EMGs) in the UK are more likely to live in deprived conditionings with a greater exposure to HDM and other aero-allergens. AIM To compare the ethnicity-based patterns of sensitisation to aero-allergens and the impact of ethnicity on clinical outcomes in patients with difficult-to-treat asthma (DTA). METHODS Data of patients with DTA were extracted from the registry of the Birmingham Regional Severe Asthma Service (BRSAS), which have a catchment population of 7.3million from Central England. Patients from White and EMG backgrounds were compared in terms of the prevalence of atopy, total serum immunoglobulin E (IgE), specific serum IgE (ssIgE) and asthma related clinical outcomes. Logistic regression analysis was conducted to explore ethnicity-based risk factors for HDM sensitisation. RESULTS A total of 1272 patients [White 1016 (79.9%), EMG 256 (20.1%) EMG] with a median age of 51 years (range 16-97) were included in the analysis. Patients from EMG were more likely (64%) to reside in the worst scale of index of multiple deprivation (IMD) than the White patients (25.5%), p < 0.0001. Positive HDM sensitisation was more prevalent in the EMG than in the White group [142/216 (66%) versus 375/842 (45%), p < 0.0001]. The median HDM ssIgE level was higher in the EMG than in the White group [3.0 KUA/L (IQR 0.06, 11.5) versus 0.1 (0.01, 3.0), p < 0.000001]. The odds ratio for positive sensitisation to HDM conveyed by the EMG status was 2.61 (95%CI, 1.8-3.8), p < 0.0001. Compared to the White group, the EMG had higher median total serum IgE [326 KU/L (115, 971) versus 114 (29.8, 434.8), p < 0.000001], higher blood eosinophil count (0.36 × 109 (0.18, 0.62) versus 0.23 (0.1,0.47), p < 0.000001), were marginally more atopic (79.2% vs. 75.6%, p = 0.098) and were less likely to being on maintenance oral corticosteroids (22% vs. 39.7%, p < 0.0001). CONCLUSION In this DTA cohort, positive HDM sensitisation was greater amongst the EMG than the White patients. The EMG status was a significant risk factor for HDM sensitisation.
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Affiliation(s)
- Adel H. Mansur
- Birmingham Regional Severe Asthma ServiceBirmingham Heartland HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
| | - Julie Marsh
- Birmingham Regional Severe Asthma ServiceBirmingham Heartland HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Ali Bahron
- Birmingham Regional Severe Asthma ServiceBirmingham Heartland HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Maximillian Thomas
- Birmingham Regional Severe Asthma ServiceBirmingham Heartland HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Gareth Walters
- Birmingham Regional Severe Asthma ServiceBirmingham Heartland HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - John Busby
- Centre for Public HealthSchool of MedicineDentistry and Biomedical SciencesQueens University BelfastBelfastUK
| | - Liam G. Heaney
- Wellcome‐Wolfson Centre for Experimental MedicineSchool of MedicineDentistry and Biomedical SciencesQueen's University BelfastBelfastUK
| | - Mamidipudi Thirumala Krishna
- Institute of Immunology and ImmunotherapyUniversity of Birminghamand University Hospitals Birmingham NHS Foundation TrustBirminghamUK
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Ramsey RR, Noser A, McDowell KM, Sherman SN, Hommel KA, Guilbert TW. Children with uncontrolled asthma from economically disadvantaged neighborhoods: Needs assessment and the development of a school-based telehealth and electronic inhaler monitoring system. Pediatr Pulmonol 2023; 58:2249-2259. [PMID: 37194988 PMCID: PMC10524439 DOI: 10.1002/ppul.26457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/11/2023] [Accepted: 04/27/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Children from economically disadvantaged communities often encounter healthcare access barriers, increasing risk for poorly controlled asthma and subsequent healthcare utilization. This highlights the need to identify novel intervention strategies for these families. OBJECTIVE To better understand the needs and treatment preferences for asthma management in children from economically disadvantaged communities and to develop a novel asthma management intervention based on an initial needs assessment and stakeholder feedback. METHODS Semistructured interviews and focus groups were conducted with 19 children (10-17 years old) with uncontrolled asthma and their caregivers, 14 school nurses, 8 primary care physicians, and three school resource coordinators from economically disadvantaged communities. Interviews and focus groups were audio-taped and transcribed verbatim and then analyzed thematically to inform intervention development. Using stakeholder input, an intervention was developed for children with uncontrolled asthma and presented to participants for feedback to fully develop a novel intervention. RESULTS The needs assessment resulted in five themes: (1) barriers to quality asthma care, (2) poor communication across care providers, (3) problems identifying and managing symptoms and triggers among families, (4) difficulties with adherence, and (5) stigma. A proposed video-based telehealth intervention was proposed to stakeholders who provided favorable and informative feedback for the final development of the intervention for children with uncontrolled asthma. CONCLUSIONS Stakeholder input and feedback provided information critical to the development of a multicomponent (medical and behavioral) intervention in a school setting that uses technology to facilitate care, collaboration, and communication among key stakeholders to improve asthma management for children from economically disadvantaged neighborhoods.
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Affiliation(s)
- Rachelle R. Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Amy Noser
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Karen M. McDowell
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center
| | | | - Kevin A. Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Theresa W. Guilbert
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center
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Chehal PK, Uppal TS, Ng BP, Alva M, Ali MK. Trends and Race/Ethnic Disparities in Diabetes-Related Hospital Use in Medicaid Enrollees: Analyses of Serial Cross-sectional State Data, 2008-2017. J Gen Intern Med 2023; 38:2279-2288. [PMID: 36385411 PMCID: PMC10406763 DOI: 10.1007/s11606-022-07842-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Race/ethnic disparities in preventable diabetes-specific hospital care may exist among adults with diabetes who have Medicaid coverage. OBJECTIVE To examine race/ethnic disparities in utilization of preventable hospital care by adult Medicaid enrollees with diabetes across nine states over time. DESIGN Using serial cross-sectional state discharge records for emergency department (ED) visits and inpatient (IP) hospitalizations from the Healthcare Cost and Utilization Project, we quantified race/ethnicity-specific, state-year preventable diabetes-specific hospital utilization. PARTICIPANTS Non-Hispanic Black, non-Hispanic White, and Hispanic adult Medicaid enrollees aged 18-64 with a diabetes diagnosis (excluding gestational or secondary diabetes) who were discharged from hospital care in Arizona, Iowa, Kentucky, Florida, Maryland, New Jersey, New York, North Carolina, and Utah for the years 2008, 2011, 2014, and 2017. MAIN MEASURES Non-Hispanic Black-over-White and Hispanic-over-White rate ratios constructed using age- standardized state-year, race/ethnicity-specific ED, and IP diabetes-specific utilization rates. KEY RESULTS The ratio of Black-over-White ED utilization rates for preventable diabetes-specific hospital care increased across the 9 states in our sample from 1.4 (CI 95, 1.31-1.50) in 2008 to 1.73 (CI 95, 1.68-1.78) in 2017. The cross-year-state average non-Hispanic Black-over-White IP rate ratio was 1.46 (CI 95, 1.42-1.50), reflecting increases in some states and decreases in others. The across-state-year average Hispanic-over-White rate ratio for ED utilization was 0.67 (CI 95, 0.63-0.71). The across-state-year average Hispanic-over-White IP hospitalization rate ratio was 0.72 (CI 95, 0.69-0.75). CONCLUSIONS Hospital utilization by non-Hispanic Black Medicaid enrollees with diabetes was consistently greater and often increased relative to utilization by White enrollees within state programs between 2008 and 2017. Hispanic enrollee hospital utilization was either lower or indistinguishable relative to White enrollee hospital utilization in most states, but Hispanic utilization increased faster than White utilization in some states. Among broader patterns, there is heterogeneity in the magnitude of race/ethnic disparities in hospital utilization trends across states.
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Affiliation(s)
- Puneet Kaur Chehal
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA.
| | - Tegveer S Uppal
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Boon Peng Ng
- College of Nursing, University of Central Florida, Orlando, FL, USA
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - Maria Alva
- Massive Data Institute, McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
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Racial bias in recruitment to clinical trials on paediatric asthma. Paediatr Respir Rev 2023; 45:8-10. [PMID: 36460568 DOI: 10.1016/j.prrv.2022.11.004] [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: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
Asthma is now the commonest chronic disease of childhood, but not all children with asthma receive equivalent standards of medical care which influences their clinical outcomes. In this paper we sought to determine the proportion of participants in registered clinical trials relating to paediatric or adolescent asthma over the last decade that were from white and non-white backgrounds. We searched the ClinicalTrials.gov database for all completed interventional studies between the dates 1st January 2011 and 1st January 2021 that were on the topic of 'asthma', and included participants below 18 years of age. Of the 500 studies returned, 208 had results available on the ClinicalTrials.gov website. In total, of the 112,327 patients studied, almost 69 % (77,333) of the patients were described as White or Caucasian, and fewer than 13 % (14,189) were described as Black, African, or African-American. Overall, approximately 30 % of study participants - some 34,207 children - were from non-white backgrounds. To redress this imbalance, researchers designing clinical trials must ensure that their study populations are as representative of the target population for the intervention as possible.
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MacDonell KK, Dailey R, Gibson-Scipio W, Wang B, Dinaj-Koci V, Bruzzese JM. Exploring Barriers to Medication Adherence Among African American Emerging Adults With Uncontrolled Asthma. HEALTH EDUCATION & BEHAVIOR 2023; 50:131-135. [PMID: 33813923 DOI: 10.1177/10901981211001345] [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: 01/26/2023]
Abstract
African American emerging adults (age 18-29 years) tend to have poor asthma outcomes, possibly due to poor adherence to medication. Few studies have explored barriers to controller adherence in this population. This study utilized electronic daily diaries to assess barriers to adherence and asthma symptoms among 141 African American emerging adults with uncontrolled persistent asthma and poor adherence. Participants reported symptoms M = 3.43 days (of 7 days). They reported unintentional (e.g., forgetting) and intentional (e.g., choosing not to take) barriers to adherence, but forgetting, being too busy, and sleeping through a dose were the most common. Significant correlations were found between symptoms and barriers, as well as asthma control and medication adherence in the expected directions. Asthma symptoms and number of barriers were significant predictors of asthma control. Existing intervention strategies such as text-messaging may prove effective to address these barriers, but measuring and addressing adherence remains complex.
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Affiliation(s)
| | | | | | - Bo Wang
- University of Massachusetts, Amherst, MA, USA
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Szefler SJ, Cicutto L, Brewer SE, Gleason M, McFarlane A, DeCamp LR, Brinton JT, Huebschmann AG. Applying dissemination and implementation research methods to translate a school-based asthma program. J Allergy Clin Immunol 2022; 150:535-548. [PMID: 35569568 PMCID: PMC9590448 DOI: 10.1016/j.jaci.2022.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022]
Abstract
Our school-based asthma program has reduced asthma exacerbations for youth with health disparities in the Denver metropolitan area, due partly to addressing social determinants of health, such as access to health care and medications. Dissemination and implementation (D&I) science approaches accelerate the translation of evidence-based programs into routine practice. D&I methods are being applied more commonly to improve health equity. The purpose of this publication was to give an overview of D&I research methods, using our school-based asthma program as an example. To successfully scale out our program across the state of Colorado, we are applying a D&I framework that guides the adaptation of our existing implementation approach to better meet our stakeholders' local context-the Exploration, Preparation, Implementation, Sustainment framework. In a pragmatic trial design, we will evaluate the outcomes of implementing the program across 5 Colorado regions, with attention to health equity, using a second commonly used D&I framework-Reach, Effectiveness, Adoption, Implementation, and Maintenance. Our central hypothesis is that our program will have broad and equitable reach to eligible students (primary outcome) and will reduce asthma attacks and symptoms. This D&I approach accelerates dissemination of our program and is an applicable process for translating other effective allergy/asthma programs to address asthma and allergy-related disparities.
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Affiliation(s)
- Stanley J Szefler
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado Breathing Institute, Aurora, Colo; Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, Aurora, Colo.
| | - Lisa Cicutto
- National Jewish Health, Aurora, Colo; Clinical Science and College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Sarah E Brewer
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, Aurora, Colo; Department of Family Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Melanie Gleason
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado Breathing Institute, Aurora, Colo
| | | | - Lisa Ross DeCamp
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, Aurora, Colo; Latino Research and Policy Center, Colorado School of Public Health, Aurora, Colo
| | - John T Brinton
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado Breathing Institute, Aurora, Colo
| | - Amy G Huebschmann
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, Aurora, Colo; Department of Medicine, Division of General Internal Medicine, University of Colorado, Aurora, Colo; Ludeman Family Center for Women's Health Research, Aurora, Colo
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10
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Kho A, Daumit GL, Truesdale KP, Brown A, Kilbourne AM, Ladapo J, Wali S, Cicutto L, Matthews AK, Smith JD, Davis PD, Schoenthaler A, Ogedegbe G, Islam N, Mills KT, He J, Watson KS, Winn RA, Stevens J, Huebschmann AG, Szefler SJ. The National Heart Lung and Blood Institute Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Alliance. Health Serv Res 2022; 57 Suppl 1:20-31. [PMID: 35383917 PMCID: PMC9108215 DOI: 10.1111/1475-6773.13983] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the National Heart Lung and Blood Institute (NHLBI) sponsored Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease (DECIPHeR) Alliance to support late-stage implementation research aimed at reducing disparities in communities with high burdens of cardiovascular and/or pulmonary disease. STUDY SETTING NHBLI funded seven DECIPHeR studies and a Coordinating Center. Projects target high-risk diverse populations including racial and ethnic minorities, urban, rural, and low-income communities, disadvantaged children, and persons with serious mental illness. Two projects address multiple cardiovascular risk factors, three focus on hypertension, one on tobacco use, and one on pediatric asthma. STUDY DESIGN The initial phase supports planning activities for sustainable uptake of evidence-based interventions in targeted communities. The second phase tests late-stage evidence-based implementation strategies. DATA COLLECTION/EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS We provide an overview of the DECIPHeR Alliance and individual study designs, populations, and settings, implementation strategies, interventions, and outcomes. We describe the Alliance's organizational structure, designed to promote cross-center partnership and collaboration. CONCLUSIONS The DECIPHeR Alliance represents an ambitious national effort to develop sustainable implementation of interventions to achieve cardiovascular and pulmonary health equity.
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Affiliation(s)
- Abel Kho
- Center for Health Information Partnerships (CHiP)Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Gail L. Daumit
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kimberly P. Truesdale
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Arleen Brown
- Department of Internal MedicineUniversity of Los Angeles School of MedicineLos AngelesCAUSA
| | - Amy M. Kilbourne
- Department of Learning Health SciencesUniversity of Michigan MedicineAnn ArborMichiganUSA
- Quality Enhancement Research Initiative (QUERI)U.S. Department of Veterans AffairsWashington, D.C.USA
| | - Joseph Ladapo
- Department of MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Soma Wali
- Department of Internal MedicineUniversity of Los Angeles School of MedicineLos AngelesCAUSA
| | - Lisa Cicutto
- Department of MedicineNational Jewish Health, Community Outreach and ResearchDenverColoradoUSA
| | | | - Justin D. Smith
- Department of Population Health SciencesUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Paris D. Davis
- Total Resource Community Development OrganizationNorthwestern UniversityChicagoIllinoisUSA
| | - Antoinette Schoenthaler
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Gbenga Ogedegbe
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Nadia Islam
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Katherine T. Mills
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
| | - Jiang He
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
| | - Karriem S. Watson
- NIH All of Us Bethesda, MD; FormerlyUniversity of Illinois in Chicago Hospital and Health Sciences System, Mile Square Health Center ChicagoIllinoisUSA
| | - Robert A. Winn
- Massey Cancer CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - June Stevens
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Amy G. Huebschmann
- Department of Medicine, Division of General Internal MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Stanley J. Szefler
- Department of PediatricsUniversity of Colorado Denver School of MedicineDenverColoradoUSA
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11
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Arenas J, Becker S, Seay H, Frisard C, Hoque S, Spano M, Lindenauer PK, Sadasivam RS, Pbert L, Trivedi M. A response to COVID-19 school closures: The feasibility of a school-linked text message intervention as an adaptation to school-supervised asthma therapy. Pediatr Pulmonol 2022; 57:1214-1222. [PMID: 35106970 PMCID: PMC9018493 DOI: 10.1002/ppul.25851] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/18/2022] [Accepted: 01/30/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND School-supervised asthma therapy improves asthma medication adherence and morbidity, particularly among low-income and underrepresented minority (URM) children. However, COVID-19-related school closures abruptly suspended this therapy. In response, we developed a school-linked text message intervention. OBJECTIVE The purpose of the study is to investigate the feasibility and acceptability of a school-linked text message intervention. METHODS In December 2020, children previously enrolled in school-supervised asthma therapy in Central Massachusetts were recruited into this school-linked text message intervention. We sent two-way, automated, daily text reminders in English or Spanish to caregivers of these children, asking if they had given their child their daily preventive asthma medicine. Our study team notified the school nurse if the caregiver did not consistently respond to text messages. School nurses performed weekly remote check-ins with all families. The primary outcome of the study was feasibility: recruitment, retention, and intervention fidelity. Secondarily we examined intervention acceptability and asthma health outcomes. RESULTS Twenty-six children (54% male, 69% Hispanic, 8% Black, 23% White, 93% Medicaid insured) and their caregivers were enrolled in the intervention with 96% participant retention at 6 months. Caregiver response rate to daily text messages was 81% over the study period. Children experienced significant improvements in asthma health outcomes. The intervention was well accepted by nurses and caregivers. CONCLUSION A school-linked text messaging intervention for pediatric asthma is feasible and acceptable. This simple, accessible intervention may improve health outcomes for low-income and URM children with asthma. It merits further study as a potential strategy to advance health equity.
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Affiliation(s)
- Juliana Arenas
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sarah Becker
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Hannah Seay
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christine Frisard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Shushmita Hoque
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Michelle Spano
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Peter K Lindenauer
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,Department of Healthcare Delivery and Population Science, Baystate Health, Springfield, MA, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Michelle Trivedi
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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12
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Ali AM, Young HN. Relationships between Key Functions of Patient-Provider Communication, Trust, and Motivation across White, African American, and Hispanic/Latino Patients with Asthma. HEALTH COMMUNICATION 2022; 37:450-456. [PMID: 33198512 DOI: 10.1080/10410236.2020.1848758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patient-provider communication is essential for providing effective care for asthma patients. However, little is known about key functions of communication and their relationships with outcomes in asthma patients across racial/ethnic groups. This study assessed asthma patients' perceptions of key functions of patient-provider communication, and examined associations between key functions, trust, and motivation across racial/ethnic groups. In this study, a sample of 470 US adults responded to an assessment of patient-provider communication, trust, and motivation through an electronically administered survey. Key functions of patient-provider communication included: exchanging information, responding to emotions, making decisions, enabling self-management, managing uncertainty, and fostering relationships. Results showed no differences in the mean scores of key functions of communication across racial/ethnic groups. The key function fostering relationships was positively associated with trust and motivation in both Whites and African Americans. However, the key function making decisions was associated with trust, and the key function managing uncertainty was associated with motivation only for Hispanic/Latinos. Results suggest different cultures may place different values on key functions of communication which may engender trust and motivation. Practical implications and suggestions for future research are discussed.
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Affiliation(s)
- Asma M Ali
- Department of Clinical and Administrative Pharmacy, University of Georgia
| | - Henry N Young
- Department of Clinical and Administrative Pharmacy, University of Georgia
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13
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Holmes LC, Orom H, Lehman HK, Lampkin S, Halterman JS, Akiki V, Supernault-Sarker AA, Butler SB, Piechowski D, Sorrentino PM, Chen Z, Wilding GE. A pilot school-based health center intervention to improve asthma chronic care in high-poverty schools. J Asthma 2022; 59:523-535. [PMID: 33322963 PMCID: PMC8281495 DOI: 10.1080/02770903.2020.1864823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To test the feasibility and effectiveness of a multifaceted intervention administered through school-based health centers (SBHCs) to improve asthma control for children in high-poverty schools with not well controlled asthma. METHODS Students 4-14 years old with persistent asthma were enrolled from three SBHCs. The centers' advanced practice providers received training on evidence-based asthma guidelines. Students randomized to the intervention received directly observed therapy of their asthma controller medication, medication adjustments as needed by the centers' providers, and daily self-management support. Students randomized to usual care were referred back to their primary care provider (PCP) for routine asthma care. RESULTS We enrolled 29 students. Students in the intervention group received their controller medication 92% of days they were in school. Ninety-four percent of follow-up assessments were completed. During the study, 11 of 12 intervention students had a step-up in medication; 2 of 15 usual care students were stepped up by their PCP. Asthma Control Test scores did not differ between groups, although there were significant improvements from baseline to the 7 month follow-up within each group (both p < .01). Both FEV1% predicted and FEV1/FVC ratio significantly worsened in the usual care group (both p = .001), but did not change in the intervention group (p = .76 and .28 respectively). CONCLUSIONS Our pilot data suggest that a multifaceted intervention can be feasibly administered through SBHCs in communities with health disparities. Despite the small sample size, spirometry detected advantages in the intervention group. Further study is needed to optimize the intervention and evaluate outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03032744.
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Affiliation(s)
- Lucy C. Holmes
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA,Corresponding author: Lucy C. Holmes, Department of Pediatrics, 1001 Main Street, Buffalo, New York 14203, (716) 323-0034,
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Heather K. Lehman
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Stacie Lampkin
- Department of Pharmacy Practice, D’Youville College, Buffalo, NY, USA
| | - Jill S. Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Vanessa Akiki
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Alicia A. Supernault-Sarker
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Denise Piechowski
- John R. Oishei Children’s Hospital, Kaleida Health, Buffalo, NY, USA
| | | | - Ziqiang Chen
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, NY USA
| | - Gregory E. Wilding
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, NY USA
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14
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Towards diversity in asthma pharmacogenetics. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:838-839. [PMID: 34762839 DOI: 10.1016/s2352-4642(21)00330-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
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15
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Tackett AP, Farrow M, Kopel SJ, Coutinho MT, Koinis-Mitchell D, McQuaid EL. Racial/ethnic differences in pediatric asthma management: the importance of asthma knowledge, symptom assessment, and family-provider collaboration. J Asthma 2021; 58:1395-1406. [PMID: 32546119 PMCID: PMC7775333 DOI: 10.1080/02770903.2020.1784191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 05/29/2020] [Accepted: 06/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Asthma disproportionately impacts youth from marginalized minority backgrounds. Aspects of core asthma management (asthma management and medication beliefs) were examined among a cohort of diverse families. METHODS Caregiver-youth dyads (N = 92; Mage= 13.8 years; non-Hispanic/Latinx White (NLW) = 40%; Black/African-American = 25%; Hispanic/Latinx= 35%) completed a medication beliefs questionnaire (Medication Necessity, Medication Concerns) and a semi-structured interview (Family Asthma Management System Scale (FAMSS)). FAMSS subscales (Asthma Knowledge, Symptom Assessment, Family Response to Symptoms, Child Response to Symptoms, Environmental Control, Medication Adherence, Family-Provider Collaboration, and Balanced Integration) were used for analyses. RESULTS More Hispanic/Latinx families were at or below the poverty line (75%) relative to NLW (22%) and Black/African-American (39%) families (p < 0.001). Adherence (p < 0.01), Knowledge (p < 0.001), and Symptom Assessment (p < 0.01) were higher for NLW relative to Black/African-American families. Collaboration was higher among NLW (p = 0.01) and Hispanic/Latinx families (p = 0.05). Effect sizes were moderate (η2= 0.10-0.12). Parental race/ethnicity moderated the relationship between adherence and parental perceived medication concern and necessity for NLW and Hispanic/Latinx families. As medication concerns increased, medication adherence decreased, however, only for NLW and Hispanic/Latinx families. CONCLUSIONS In this sample, racial/ethnic differences emerged for elements of asthma management. Interview-based ratings of asthma management among Black/African-American families depicted lower asthma knowledge, lower levels of family-provider collaboration, and lower medication adherence. The relationship between medication concerns and adherence appeared to differ by ethnic group. Future research is needed to elucidate cultural factors that influence family-provider relationships and health-related behaviors, like medication use/adherence.
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Affiliation(s)
- Alayna P Tackett
- Oklahoma Tobacco Research Center, University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK, USA
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michael Farrow
- Bradley-Hasbro Children's Research Center, Providence, RI, USA
| | - Sheryl J Kopel
- Bradley-Hasbro Children's Research Center, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School Brown University, Providence, RI, USA
| | - Maria T Coutinho
- Bradley-Hasbro Children's Research Center, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School Brown University, Providence, RI, USA
| | - Daphne Koinis-Mitchell
- Bradley-Hasbro Children's Research Center, Providence, RI, USA
- Department of Psychiatry and Human Behavior and Pediatrics, Warren Alpert Medical School Brown University, Providence, RI, USA
| | - Elizabeth L McQuaid
- Bradley-Hasbro Children's Research Center, Providence, RI, USA
- Department of Psychiatry and Human Behavior and Pediatrics, Warren Alpert Medical School Brown University, Providence, RI, USA
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16
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Sheikh SI, Ryan-Wenger NA, Pitts J, Britt R, Paul G, Ulrich L. Impact of guideline adherence and race on asthma control in children. World J Pediatr 2021; 17:500-507. [PMID: 34586609 DOI: 10.1007/s12519-021-00458-5] [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: 04/09/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Asthma control in African Americans (AA) is considered more difficult to achieve than in Caucasian Americans (CA). The aim of this study was to compare asthma control over time among AA and CA children whose asthma is managed per NAEPP (EPR-3) guidelines. METHODS This was a one-year prospective study of children referred by their primary care physicians for better asthma care in a specialty asthma clinic. All children received asthma care per NAEPP guidelines. Results were compared between CA and AA children at baseline and then at three-month intervals for one year. RESULTS Of the 345 children, ages 2-17 years (mean = 6.2 ± 4), 220 (63.8%) were CA and 125 (36.2%) were AA. There were no significant differences in demographics other than greater pet ownership in CA families. At baseline, AA children had significantly more visits to the Emergency Department for acute asthma symptoms (mean = 2.3 [Formula: see text] compared to CA (1.4 ± 2.3, P = 0.003). There were no other significant differences in acute care utilization, asthma symptoms (mean days/month), or mean asthma control test (ACT) scores at baseline. Within 3-6 months, in both groups, mean ACT scores, asthma symptoms and acute care utilization significantly improved (P < 0.05 for all) and change over time in both groups was comparable except for a significantly greater decrease in ED visits in AA children compared to CA children (P = 002). CONCLUSION Overall, improvement in asthma control during longitudinal assessment was similar between AA and CA children because of consistent use of NAEPP asthma care guidelines.
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Affiliation(s)
- Shahid I Sheikh
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. .,Section of Pulmonary Medicine, Nationwide Children's Hospital, ED 544 Education Building, 700 Children's Drive, Columbus, OH, USA.
| | - Nancy A Ryan-Wenger
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Judy Pitts
- Section of Pulmonary Medicine, Nationwide Children's Hospital, ED 544 Education Building, 700 Children's Drive, Columbus, OH, USA
| | - Rodney Britt
- Department of Perinatal Research, Wexner Research Center, Columbus, OH, USA
| | - Grace Paul
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, ED 544 Education Building, 700 Children's Drive, Columbus, OH, USA
| | - Lisa Ulrich
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, ED 544 Education Building, 700 Children's Drive, Columbus, OH, USA
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17
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Torres-Zevallos H, Guerreros AG, Bazo-Alvarez JC, Alvarado GF, Vazquez K, Feldman JM, Ritz T. Evaluation of a Spanish language version of the Asthma Trigger Inventory. J Asthma 2021; 58:825-833. [PMID: 32089019 PMCID: PMC11337968 DOI: 10.1080/02770903.2020.1734022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
Abstract
Background: Perceptions of asthma triggers provide important guidance for patients' disease management. A psychometrically valid instrument, the Asthma Trigger Inventory (ATI), is available in English and German language versions, however, a version in Spanish as major world language has been missing.Method: A Spanish-language version of the ATI was evaluated in 339 adult patients with asthma, 223 of these in Peru and 107 in the USA. Principal Component analysis (PCA) with Varimax rotation was used to identify coherent trigger domains across and within samples. Resulting subscales were evaluated for internal consistency.Results: PCA suggested differences in factor structures between sites. Whereas the USA sample largely replicated original factors for animal allergens, pollen allergens, physical activity, air pollution/irritants, infections, and psychology, the initial analysis of the Peru sample suggested substantial overlap of air pollution/irritant, infection, and allergen items. Subsequent analysis of an expanded research form of the ATI for the Peru site culminated in extraction of five factors related to psychology, climate/temperature, combined pollen and animal allergens, physical activity, and infection. Internal consistencies were in an acceptable to excellent range (α = 0.74 to 0.94). Additional free trigger responses confirmed the importance of climate variables for patients in Peru. Psychological triggers were reported by 26% (Peru) and 31% (USA) of patients.Conclusion: Coherent trigger domains are readily identified and measured reliably by a Spanish-language ATI version. However, factor structures vary between samples from different Hispanic/Latino cultural and geographic domains. Culturally adapted versions of this instrument are therefore required for Hispanic/Latino population studies.
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Affiliation(s)
- Hernando Torres-Zevallos
- Facultad de Salud Pública y Administración “Carlos Vidal Layseca,” Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Juan C. Bazo-Alvarez
- Instituto de Investigación, Universidad Católica Los Angeles de Chimbote, Chimbote, Peru
| | - German F. Alvarado
- Facultad de Salud Pública y Administración “Carlos Vidal Layseca,” Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Jonathan M. Feldman
- Albert Einstein College of Medicine/Montefiore Medical Center, Ferkauf Graduate School of Psychology/Yeshiva University, Bronx, NY, USA
| | - Thomas Ritz
- Southern Methodist University, Dallas, TX, USA
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18
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Cremer NM, Baptist AP. Race and Asthma Outcomes in Older Adults: Results from the National Asthma Survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1294-1301.e7. [PMID: 32035849 DOI: 10.1016/j.jaip.2019.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The number of older adults with asthma continues to rise, yet the effects of race and ethnicity on asthma outcomes in this population are unknown. OBJECTIVE To characterize the effect of race and ethnicity on asthma outcomes in a large national sample of older adults and to identify factors that are associated with disparities found. METHODS Data from the 2015 Behavioral Risk Factor Surveillance Survey and Asthma Call-Back Survey were analyzed. Respondents were included if they had a current asthma diagnosis, were aged ≥55, and self-identified as non-Hispanic white, African American, or Hispanic. Demographic variables, health care access, comorbidities, and asthma history were correlated with asthma outcomes (health care utilization and asthma control). Asthma outcome variables were further analyzed using multivariable logistic regression. RESULTS A total of 4700 individuals were included. Compared with non-Hispanic white respondents, African American and Hispanic respondents had lower incomes, greater impaired access to health care due to cost, and increased reliance on rescue medications. After controlling for factors including income, education, comorbidities, and health insurance, African American and Hispanic respondents were twice as likely to visit the emergency room (ER) for asthma (P < .001 for both) and 40% less likely to report uncontrolled daytime symptoms (P = .002 and .008). CONCLUSIONS Racial differences in asthma outcomes persist despite controlling for multiple social determinants of health and access to health insurance through Medicare. Minority patients were more likely to visit the ER but less likely to report frequent daytime symptoms. These findings indicate that comprehensive strategies to address assessment, monitoring, and treatment are needed to decrease health disparities.
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Affiliation(s)
- Nicole M Cremer
- Division of Internal Medicine, University of Michigan, Ann Arbor, Mich.
| | - Alan P Baptist
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
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19
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Abstract
PURPOSE OF REVIEW Asthma attacks are frequent in children with asthma and can lead to significant adverse outcomes including time off school, hospital admission and death. Identifying children at risk of an asthma attack affords the opportunity to prevent attacks and improve outcomes. RECENT FINDINGS Clinical features, patient behaviours and characteristics, physiological factors, environmental data and biomarkers are all associated with asthma attacks and can be used in asthma exacerbation prediction models. Recent studies have better characterized children at risk of an attack: history of a severe exacerbation in the previous 12 months, poor adherence and current poor control are important features which should alert healthcare professionals to the need for remedial action. There is increasing interest in the use of biomarkers. A number of novel biomarkers, including patterns of volatile organic compounds in exhaled breath, show promise. Biomarkers are likely to be of greatest utility if measured frequently and combined with other measures. To date, most prediction models are based on epidemiological data and population-based risk. The use of digital technology affords the opportunity to collect large amounts of real-time data, including clinical and physiological measurements and combine these with environmental data to develop personal risk scores. These developments need to be matched by changes in clinical guidelines away from a focus on current asthma control and stepwise escalation in drug therapy towards inclusion of personal risk scores and tailored management strategies including nonpharmacological approaches. SUMMARY There have been significant steps towards personalized prediction models of asthma attacks. The utility of such models needs to be tested in the ability not only to predict attacks but also to reduce them.
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20
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Zablotsky B, Black LI. Concordance between survey reported childhood asthma and linked Medicaid administrative records. J Asthma 2019; 56:285-295. [PMID: 29771597 PMCID: PMC6240395 DOI: 10.1080/02770903.2018.1455854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/27/2018] [Accepted: 03/19/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Agreement between administrative and survey data has been shown to vary by the condition of interest and there is limited research dedicated to parental report of asthma among children. The current study assesses the concordance between parent-reported asthma from the National Health Interview Survey (NHIS) with Medicaid administrative claims data among linkage eligible children from the NHIS. METHODS Medicaid Analytic eXtract (MAX) files from the Centers for Medicare & Medicaid Services (CMS) (years 2000-2005) were linked to participants of the NHIS (years 2001-2005). Concordance measures were calculated to assess overall agreement between a claims-based asthma diagnosis and a survey-based asthma diagnosis. Structural equation modeling was used to assess the association between demographic, service utilization, and co-occurring conditions factors and agreement. RESULTS Percent agreement between the two data sources was high (90%) with a prevalence-adjusted bias-adjusted kappa of 0.80 and Cohen's kappa of 0.55. Agreement varied by demographic characteristics, service utilization characteristics, and the presence of allergies and other health conditions. Structural equation modeling results found the presence of a series of co-occurring conditions, namely allergies, resulted in significantly lower agreement after controlling for demographics and service utilization. CONCLUSIONS There was general agreement between asthma diagnoses reported in the NHIS when compared to medical claims. Discordance was greatest among children with co-occurring conditions.
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Affiliation(s)
| | - Lindsey I Black
- a National Center for Health Statistics , Hyattsville , MD , USA
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21
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Molina AL, Magruder TG, Aban IB, Ward L, Narayanan S, Walley SC. Predictors of Hospital Reuse Among Publicly Insured Children Hospitalized for Status Asthmaticus. Hosp Pediatr 2019; 9:194-200. [PMID: 30718385 DOI: 10.1542/hpeds.2017-0239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Asthma is a common cause of pediatric hospitalization. Nonadherence to asthma medications is associated with worse outcomes; however, there is a paucity of data regarding posthospitalization prescription filling and hospital reuse. Our objective was to identify patients at risk for hospital reuse after being hospitalized for asthma. METHODS This is a retrospective study of patients with asthma who were discharged from a children's hospital in which we use Medicaid claims data to evaluate prescription fills within 30 days and 12 months. Chart reviews were used for demographics, chronic asthma severity, admission severity, and hospital reuse. t and χ2 tests were performed for continuous and categorical variables. A generalized linear mixed model was fitted to predict the odds of hospital reuse, which was defined as requiring an emergency department visit or rehospitalization. Survival analysis using log-rank testing was used for modeling the time to hospital reuse. RESULTS Fifty-four percent of patients discharged with asthma had hospital reuse within 1 year of discharge. There was no association between hospital reuse and prescription filling for systemic steroids (odds ratio [OR] 1.30; confidence interval [CI]: 0.85-2.00; P = .21) or controller medications (OR 1.5; CI: 0.92-2.52; P = .10). There was a higher number of controller and systemic steroid prescription fills over 12 months for patients with hospital reuse. The factors associated with greater odds of hospital reuse were severity of chronic asthma diagnosis (P = .03) as well as African American race (OR 1.92; CI: 1.17-3.13; P = .01). CONCLUSIONS For Medicaid-insured patients discharged with asthma, worse chronic asthma severity and African American race were associated with greater odds of hospital reuse. Decreased prescription filling was not associated with greater odds of hospital reuse.
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Affiliation(s)
| | | | - Inmaculada B Aban
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Lauren Ward
- Viva Health, Inc, University of Alabama at Birmingham Health System, Birmingham, Alabama
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22
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Zhang J, Ma C, Yang A, Zhang R, Gong J, Mo F. Is preterm birth associated with asthma among children from birth to 17 years old? -A study based on 2011-2012 US National Survey of Children's Health. Ital J Pediatr 2018; 44:151. [PMID: 30579359 PMCID: PMC6303925 DOI: 10.1186/s13052-018-0583-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 11/11/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Preterm birth can interrupt lung development in utero and is associated with early life factors, which adversely affects the developing respiratory system. Studies on preterm birth and asthma risk are comparatively sparse and the results are not consistent. METHODS Multivariate analyses were performed on a cross-sectional data from the National Survey of Children's Health (NSCH) collected in 2011 to 2012. The NSCH was a nationally representative telephone survey sponsored by the Maternal and Child Health Bureau and conducted by the National Center for Health Statistics. A cross-sectional analysis using data from the US on 90,721 children was conducted to examine the relationship between preterm birth and asthma risk. RESULTS A total of 90,721 children under 17 years were included and 12% of the children were reported as preterm birth. The prevalence of diagnosed asthma was 15%, with a male to female ratio of 1.26:1. Children who were born preterm were 1.64 times (95% confidence interval: 1.45-1.84) more likely to develop asthma compared with those who were born term after controlling for confounders. Similarly, children who were low birth weight were 1.43 times (95% confidence interval: 1.25-1.63) more likely for asthma, and the odds ratio increased to 1.77 for those both preborn and low birth weight. Child's gender, race/ethnicity, age, family structure, family income levels, and household smoking were significantly associated with the odds of reported asthma. CONCLUSIONS Preterm birth was associated with increased risk of asthma among US children, supporting the notion that preterm birth may play a critical role in asthma development.
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Affiliation(s)
- Jie Zhang
- Department of Ship Hygiene, Faculty of Naval Medicine, Second Military Medical University, Shanghai, 200433 China
- School of Public Health, Brown University, Providence, RI USA
| | - Chenchao Ma
- Department of thoracic surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Aimin Yang
- School of Public Health, Brown University, Providence, RI USA
| | - Rongqiang Zhang
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jiannan Gong
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Fengfeng Mo
- Department of Ship Hygiene, Faculty of Naval Medicine, Second Military Medical University, Shanghai, 200433 China
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Krishnan S, Rohman A, Welter J, Dozor AJ. Relationship Between Health Literacy in Parents and Asthma Control in Their Children: A Prospective Study in a Diverse Suburban Population. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2018. [DOI: 10.1089/ped.2018.0929] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sankaran Krishnan
- New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York
| | | | - John Welter
- New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York
| | - Allen J. Dozor
- New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York
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Sadreameli SC, Riekert KA, Matsui EC, Rand CS, Eakin MN. Family Caregiver Marginalization is Associated With Decreased Primary and Subspecialty Asthma Care in Head Start Children. Acad Pediatr 2018; 18:905-911. [PMID: 29730244 PMCID: PMC6215521 DOI: 10.1016/j.acap.2018.04.135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/27/2018] [Accepted: 04/29/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Urban minority children are at risk for poor asthma outcomes and might not receive appropriate primary or subspecialty care. We hypothesized that preschool children with asthma whose caregivers reported more barriers to care would be less likely to have seen their primary care provider (PCP) or an asthma subspecialist and more likely to have had a recent emergency department (ED) visit for asthma. METHODS The Barriers to Care Questionnaire (BCQ) is used to measure expectations, knowledge, marginalization, pragmatics, and skills. We assessed asthma control using the Test for Respiratory and Asthma Control in Kids and these outcomes: PCP visits for asthma in the past 6 months, subspecialty care (allergist or pulmonologist) in the past 2 years, and ED visits in the past 3 months. RESULTS Three hundred ninety-five caregivers (96% African-American, 82% low-income, 96% Medicaid) completed the BCQ. Sixty percent (n = 236) of children had uncontrolled asthma, 86% had seen a PCP, 23% had seen a subspecialist, and 29% had an ED visit. Barriers related to marginalization were associated with decreased likelihood of PCP (odds ratio [OR], 0.95; P = .014) and subspecialty visits (OR, 0.92; P = .019). Overall BCQ score was associated with decreased likelihood of subspecialty care (OR, 0.98; P = .027). Barriers related to expectations, knowledge, pragmatics, and skills were not associated with any of the care outcomes. CONCLUSIONS Among low-income, predominantly African-American preschool children with asthma, primary and subspecialty care were less likely if caregivers reported past negative experiences with the health care system (marginalization). Clinicians who serve at-risk populations should be sensitive to families' past experiences and should consider designing interventions to target the most commonly reported barriers.
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Affiliation(s)
- S. Christy Sadreameli
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kristin A. Riekert
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth C. Matsui
- Eudowood Division of Pediatric Allergy and Immunology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Cynthia S. Rand
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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MacDonell K, Naar S, Gibson-Scipio W, Bruzzese JM, Wang B, Brody A. The Detroit Young Adult Asthma Project: Proposal for a Multicomponent Technology Intervention for African American Emerging Adults With Asthma. JMIR Res Protoc 2018; 7:e98. [PMID: 29735474 PMCID: PMC5962828 DOI: 10.2196/resprot.8872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 02/12/2018] [Accepted: 02/15/2018] [Indexed: 12/31/2022] Open
Abstract
Background Racial and ethnic minority youth have poorer asthma status than white youth, even after controlling for socioeconomic variables. Proper use of asthma controller medications is critical in reducing asthma mortality and morbidity. The clinical consequences of poor asthma management include increased illness complications, excessive functional morbidity, and fatal asthma attacks. There are significant limitations in research on interventions to improve asthma management in racial minority populations, particularly minority adolescents and young adults, although illness management tends to deteriorate after adolescence during emerging adulthood, the unique developmental period beyond adolescence but before adulthood. Objective The objective of the pilot study was to test the feasibility, acceptability, and signals of efficacy of an intervention targeting adherence to controller medication in African American youth (ages 18-29) with asthma. All elements of the protocol were piloted in a National Heart, Lung, and Blood Institute (NHLBI)–funded pilot study (1R34HL107664 MacDonell). Results suggested feasibility and acceptability of the protocol as well as proof of concept. We are now ready to test the intervention in a larger randomized clinical trial. Methods The proposed study will include 192 African American emerging adults with moderate to severe persistent asthma and low controller medication adherence recruited from clinic, emergency department, and community settings. Half of the sample will be randomized to receive a multicomponent technology-based intervention targeting adherence to daily controller medication. The multicomponent technology-based intervention consists of 2 components: (1) 2 sessions of computer-delivered motivational interviewing targeting medication adherence and (2) individualized text messaging focused on medication adherence between the sessions. Text messages will be individualized based on ecological momentary assessment. The remaining participants will complete a series of computer-delivered asthma education modules matched for length, location, and method of delivery of the intervention session. Control participants will also receive text messages between intervention sessions. Message content will be the same for all control participants and contain general facts about asthma (not tailored). Results It is hypothesized that youth randomized to multicomponent technology-based intervention will show improvements in medication adherence (primary outcome) and asthma control (secondary outcome) compared with comparison condition at all postintervention follow-ups (3, 6, 9, and 12 months). The proposed study was funded by NHLBI from September 1, 2016 through August 31, 2021. Conclusions This project will test a brief, technology-based intervention specifically targeting adherence to asthma controller medications in an under-researched population, African American emerging adults. If successful, our multicomponent technology-based intervention aimed at improving adherence to asthma medications has the potential to improve quality of life of minority emerging adults with asthma at relatively low cost. It could eventually be integrated into clinical settings and practice to reach a large number of emerging adults with asthma. Trial Registration ClinicalTrials.gov NCT03121157; https://clinicaltrials.gov/ct2/show/NCT03121157 (Archived by WebCite at http://www.webcitation.org/6wq4yWHPv)
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Affiliation(s)
- Karen MacDonell
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, United States
| | - Sylvie Naar
- Florida State University, Tallahassee, FL, United States
| | | | | | - Bo Wang
- Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts, Amherst, MA, United States
| | - Aaron Brody
- Department of Emergency Medicine, Wayne State University, Detroit, MI, United States
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McQuaid EL. Barriers to medication adherence in asthma: The importance of culture and context. Ann Allergy Asthma Immunol 2018; 121:37-42. [PMID: 29580846 DOI: 10.1016/j.anai.2018.03.024] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Significant disparities exist in asthma outcomes. Racial and ethnic minorities have lower controller medication adherence, which may contribute to differences in asthma morbidity between minority and non-minority groups. The objective of this review is to identify individual, patient-provider communication, and systems issues that contribute to this pattern of medication underuse and to discuss potential strategies for intervention. DATA SOURCES Data were gathered from numerous sources, including reports of pharmacy and medical records, observational studies, and trials. STUDY SELECTIONS Studies analyzed factors contributing to patterns of asthma medication adherence that differ by race and ethnicity. RESULTS There is clear evidence of underuse of asthma controller medications among racial and ethnic minorities in prescription receipt, prescription initiation, and medication use once obtained. Individual factors such as medication beliefs and depressive symptoms play a role. Provider communication is also relevant, including limited discussion of complementary and alternative medicine use, difficulties communicating with patients and caregivers with limited English proficiency, and implicit biases regarding cultural differences. Systems issues (eg, insurance status, cost) and social context factors (eg, exposure to violence) also present challenges. Culturally informed strategies that capitalize on patient strengths and training providers in culturally informed communication strategies hold promise as intervention approaches. CONCLUSION Disparities in controller medication use are pervasive. Identifying the sources of these disparities is a critical step toward generating intervention approaches to enhance disease management among the groups that bear the greatest asthma burden.
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Affiliation(s)
- Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island; Department of Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island.
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27
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Routh JC, Joseph DB, Liu T, Schechter MS, Thibadeau JK, Wallis MC, Ward EA, Wiener JS. Bladder Reconstruction Rates Differ among Centers Participating in National Spina Bifida Patient Registry. J Urol 2018; 199:268-273. [PMID: 28830753 PMCID: PMC5760329 DOI: 10.1016/j.juro.2017.08.084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We performed an exploratory analysis of data from the NSBPR (National Spina Bifida Patient Registry) to assess variation in the frequency of bladder reconstruction surgeries among NSBPR centers. MATERIALS AND METHODS We queried the 2009-2014 NSBPR to identify patients who had ever undergone bladder reconstruction surgeries. We evaluated demographic characteristics, spina bifida type, functional level, mobility and NSBPR center to determine whether any of these factors were associated with reconstructive surgery rates. Multivariable logistic regression was used to simultaneously adjust for the impact of these factors. RESULTS We identified 5,528 patients with spina bifida enrolled in the NSBPR. Of these patients 1,129 (20.4%) underwent bladder reconstruction (703 augmentation, 382 continent catheterizable channel, 189 bladder outlet procedure). Surgical patients were more likely older, female, nonHispanic white, with a higher lesion level, myelomeningocele diagnosis, nonambulators (all p <0.001) and nonprivately insured (p=0.018). Bladder reconstruction surgery rates varied among NSBPR centers (range 12.1% to 37.9%, p <0.001). After correcting for known confounders NSBPR center, spina bifida type, mobility, gender and age (all p <0.001) were significant predictors of surgical intervention. Race (p=0.19) and insurance status (p=0.11) were not associated with surgical intervention. CONCLUSIONS There is significant variation in rates of bladder reconstruction surgery among NSBPR centers. In addition to clinical factors such as mobility status, lesion type and lesion level, nonclinical factors such as patient age, gender and treating center are also associated with the likelihood of an individual undergoing bladder reconstruction.
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Affiliation(s)
- Jonathan C Routh
- Division of Urology, Duke University Medical Center, Durham, North Carolina.
| | - David B Joseph
- Department of Urology, University of Alabama-Birmingham, Birmingham, Alabama
| | - Tiebin Liu
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael S Schechter
- Division of Pediatric Pulmonary Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Judy K Thibadeau
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Chad Wallis
- Division of Urology, Primary Children's Hospital, Salt Lake City, Utah
| | - Elisabeth A Ward
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; Carter Consulting, Inc., Atlanta, Georgia
| | - John S Wiener
- Division of Urology, Duke University Medical Center, Durham, North Carolina
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Routh JC, Joseph DB, Liu T, Schechter MS, Thibadeau JK, Wallis MC, Ward EA, Wiener JS. Variation in surgical management of neurogenic bowel among centers participating in National Spina Bifida Patient Registry. J Pediatr Rehabil Med 2017; 10:303-312. [PMID: 29125521 PMCID: PMC5891120 DOI: 10.3233/prm-170460] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Optimal management of neurogenic bowel in patients with spina bifida (SB) remains controversial. Surgical interventions may be utilized to treat constipation and provide fecal continence, but their use may vary among SB treatment centers. METHODS We queried the National Spina Bifida Patient Registry (NSBPR) to identify patients who underwent surgical interventions for neurogenic bowel. We abstracted demographic characteristics, SB type, functional level, concurrent bladder surgery, mobility, and NSBPR clinics to determine whether any of these factors were associated with interventions for management of neurogenic bowel. Multivariable logistic regression with adjustment for selection bias was performed. RESULTS We identified 5,528 patients with SB enrolled in the 2009-14 NSBPR. Of these, 1,088 (19.7%) underwent procedures for neurogenic bowel, including 957 (17.3%) ACE/cecostomy tube and 155 (2.8%) ileostomy/colostomy patients. Procedures were more likely in patients who were older, white, non-ambulatory, with higher-level lesion, with myelomeningocele lesion, with private health insurance (all p< 0.001), and female (p= 0.006). On multivariable analysis, NSBPR clinic, older age (both p< 0.001), race (p= 0.002), mobility status (p= 0.011), higher lesion level (p< 0.001), private insurance (p= 0.002) and female sex (p= 0.015) were associated with increased odds of surgery. CONCLUSIONS There is significant variation in rates of procedures to manage neurogenic bowel among NSBPR clinics. In addition to SB-related factors such as mobility status and lesion type/level, non-SB-related factors such as patient age, sex, race and treating center are also associated with the likelihood of undergoing neurogenic bowel intervention.
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Affiliation(s)
- Jonathan C. Routh
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - David B. Joseph
- Department of Urology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Tiebin Liu
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA
| | - Michael S. Schechter
- Division of Pediatric Pulmonary Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Judy K. Thibadeau
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA
| | - M. Chad Wallis
- Division of Urology, Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Elisabeth A. Ward
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA
- Carter Consulting, Inc., Atlanta, GA, USA
| | - John S. Wiener
- Division of Urology, Duke University Medical Center, Durham, NC, USA
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Snieder HM, Nickels S, Gleason M, McFarlane A, Szefler SJ, Allison MA. Stakeholder Perspectives on Optimizing Communication in a School-Centered Asthma Program. THE JOURNAL OF SCHOOL HEALTH 2017; 87:941-948. [PMID: 29096412 DOI: 10.1111/josh.12565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 03/24/2017] [Accepted: 06/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND School-centered asthma programs (SAPs) can be an effective intervention to improve asthma control for underserved populations but little is known about how key stakeholders communicate within these programs. Therefore, our aim was to identify key components of effective communication in a SAP. METHODS Primary care providers (PCPs), parents and school nurses associated with a SAP in Denver, Colorado participated in interviews and focus groups about their views on effective communication. Interview and focus group guides were developed using an appreciative inquiry approach and transcripts were analyzed via an iterative coding approach. RESULTS We conducted 3 focus groups with school nurses (N = 13), interviews with parents (N = 12) and PCPs (N = 10). Stakeholders identified multiple themes that enable communication, namely personal relationships, clear roles, integration of technology, adequate resources, and accessibility. CONCLUSIONS Communication in SAPs is most effective when there are clearly delineated roles with the school being the focal point for education and monitoring of asthmatic students and PCPs being the focal point for diagnosis and changes in care. Communication should take place using modern technology that is integrated into existing workflow. Information sharing is most likely to be successful if there is deliberate relationship building.
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Affiliation(s)
- Hylke M Snieder
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Mail Stop F443, 13199 East Montview Boulevard, Suite 300, Aurora, CO 80045
| | - Sarah Nickels
- Clinical Effectiveness, Children's Hospital Colorado, Aurora, CO 80045
| | - Melanie Gleason
- Building Bridges, The Breathing Institute, Children's Hospital Colorado, Aurora, CO 80045
| | - Arthur McFarlane
- The Breathing Institute, Children's Hospital Colorado, Aurora, CO 80045
| | - Stanley J Szefler
- Department of Pediatrics, University of Colorado, Director, Pediatric Asthma Research Program, The Breathing Institute, Children's Hospital Colorado, Aurora, CO 80045
| | - Mandy A Allison
- Department of Pediatrics, University of Colorado, ACCORDS, Aurora, CO 80045
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Childs E, Laws MA, Drainoni ML, Nath A, Reid MJ, Sandel M, Cohen RT. Caring for Young Children with Asthma: Perspectives from Urban Community Health Centers. J Urban Health 2017; 94:824-834. [PMID: 28741283 PMCID: PMC5722725 DOI: 10.1007/s11524-017-0186-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Asthma disproportionately affects low-income, minority youth, with notable disparities among children <5 years of age. Understanding the perceptions of urban community health centers (CHCs) regarding treating young children with asthma could improve care for these patients. This study uses data from semi-structured focus groups with staff from eight urban CHCs. Themes emerged in three domains. Within the parent/family domain, providers noted low rates of follow-up visits, low health literacy, and-for young children specifically-misunderstanding about the diagnosis. At the CHC level, providers needed more staff, space, and comfort with applying the guidelines to infants and young children. CHCs reported asthma registries, population health oversight, and an asthma champion improved care. At the system level, providers wanted improved communication with emergency departments and community outreach programs. Reducing these multi-level barriers may improve care.
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Affiliation(s)
- Ellen Childs
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot 3W, Boston, MA, 02118, USA.
| | - Margaret A Laws
- Department of Pediatrics, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot 3W, Boston, MA, 02118, USA.,Section of Infectious Diseases, Department of Medicine, Boston University, Boston, MA, USA.,Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, Bedford, MA, USA
| | - Anjali Nath
- Division of Healthy Homes and Community Supports, Boston Public Health Commission, Boston, MA, USA
| | - Margaret J Reid
- Office of Health Equity, Boston Public Health Commission, Boston, MA, USA
| | - Megan Sandel
- Department of Pediatrics, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Robyn T Cohen
- Department of Pediatrics, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
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31
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Washington DM, Curtis LM, Waite K, Wolf MS, Paasche-Orlow MK. Sociodemographic Factors Mediate Race and Ethnicity-associated Childhood Asthma Health Disparities: a Longitudinal Analysis. J Racial Ethn Health Disparities 2017; 5:928-938. [PMID: 29188553 DOI: 10.1007/s40615-017-0441-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/05/2017] [Accepted: 10/09/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Race and ethnicity-based disparities in childhood asthma are well established. We characterized the longitudinal effects associated with being African-American/Black or Hispanic/Latino on a range of asthma outcomes, and the extent to which sociodemographic factors, caregiver health literacy, education level, and asthma knowledge mediate these associations. METHODS Children ages 8-15 and their caregivers (n = 544) in the Chicago Initiative to Raise Asthma Health Equity (CHIRAH) cohort completed interviews every 3 months for 1.5 years. Health literacy was measured with the Rapid Estimate of Adult Literacy in Medicine (REALM). Other covariates include sex, age, education level, income, smoke exposure, asthma duration, employment status, and insurance status. We conducted a series of models to evaluate these factors as mediators of the relationship between race/ethnicity and (1) asthma knowledge, (2) asthma-related quality of life, (3) asthma severity, and (4) asthma control based on NAEPP/EPR-3 2007 guidelines. RESULTS African-American race and Hispanic/Latino ethnicity were significantly associated with all outcomes when compared to Whites. Adjusting for sociodemographic factors resulted in the most significant mediation of racial/ethnic disparities in all outcomes. Health literacy was a partial mediator of race/ethnic disparities in asthma knowledge and asthma-related quality of life. Asthma knowledge remained significantly associated with race and ethnicity, and race remained associated with asthma-related quality of life. CONCLUSIONS African-American race and Hispanic/Latino ethnicity are significantly associated with worse asthma compared to Whites in longitudinal analyses. Sociodemographic factors are potent mediators of these disparities, and should be considered when designing interventions to reduce asthma disparities. Health literacy and education level are partial mediators.
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Affiliation(s)
- David M Washington
- Boston Medical Center, Boston, MA, USA. .,Internal Medicine and Pediatrics, Texas Gulf Coast Medical Systems, 250 Blossom Street, Suite 400, Webster, TX, 77598, USA.
| | - Laura M Curtis
- Northwestern University: Feinberg School of Medicine, Chicago, IL, USA
| | | | - Michael S Wolf
- Northwestern University: Feinberg School of Medicine, Chicago, IL, USA
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Dong Z, Nath A, Guo J, Bhaumik U, Chin MY, Dong S, Marshall E, Murphy JS, Sandel MT, Sommer SJ, Ursprung WWS, Woods ER, Reid M, Adamkiewicz G. Evaluation of the Environmental Scoring System in Multiple Child Asthma Intervention Programs in Boston, Massachusetts. Am J Public Health 2017; 108:103-111. [PMID: 29161061 DOI: 10.2105/ajph.2017.304125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To test the applicability of the Environmental Scoring System, a quick and simple approach for quantitatively measuring environmental triggers collected during home visits, and to evaluate its contribution to improving asthma outcomes among various child asthma programs. METHODS We pooled and analyzed data from multiple child asthma programs in the Greater Boston Area, Massachusetts, collected in 2011 to 2016, to examine the association of environmental scores (ES) with measures of asthma outcomes and compare the results across programs. RESULTS Our analysis showed that demographics were important contributors to variability in asthma outcomes and total ES, and largely explained the differences among programs at baseline. Among all programs in general, we found that asthma outcomes were significantly improved and total ES significantly reduced over visits, with the total Asthma Control Test score negatively associated with total ES. CONCLUSIONS Our study demonstrated that the Environmental Scoring System is a useful tool for measuring home asthma triggers and can be applied regardless of program and survey designs, and that demographics of the target population may influence the improvement in asthma outcomes.
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Affiliation(s)
- Zhao Dong
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Anjali Nath
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Jing Guo
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Urmi Bhaumik
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - May Y Chin
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Sherry Dong
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Erica Marshall
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Johnna S Murphy
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Megan T Sandel
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Susan J Sommer
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - W W Sanouri Ursprung
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Elizabeth R Woods
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Margaret Reid
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Gary Adamkiewicz
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
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Warman KL, Silver EJ. Are inner-city children with asthma receiving specialty care as recommended in national asthma guidelines? J Asthma 2017; 55:517-524. [PMID: 28813166 DOI: 10.1080/02770903.2017.1350966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine whether children with asthma in an urban health care network are receiving asthma specialty care, and which factors, if any, are associated with the receipt of this care, including child's racial/ethnic group, age, socio-economic status (SES), insurance, and/or acute care utilization. METHODS This study is a retrospective cohort study of children aged 7-17 years who received primary care at an urban medical center in 2012 and had a primary or secondary ICD9 code for asthma. Data on asthma-related health care utilization from 1997 to 2012 were accessed using a software application linked to the electronic medical record. Analyses included descriptive statistics (means and percentages) as well as bivariate and multivariable logistic regressions. RESULTS The participants were 4959 children (59% Hispanic and 37% Black, Non-Hispanic) with a mean age = 11.1 years ± 3.05, with 56.8% males. Only 19% of the children had outpatient asthma specialist care: pulmonary (16%) and/or allergy (7%). Only 42% with an asthma-related hospitalization had an outpatient asthma specialist visit. The receipt of specialty care did not vary by race/ethnicity, SES or private vs. public insurance, but was more likely with hospitalization for asthma (OR 3.4) or ≥2 lifetime ED visits (OR 2.6) and less likely for those who were uninsured (OR 0.7). CONCLUSIONS In contrast to guideline recommendations, few inner-city children with high asthma morbidity in this sample had seen asthma specialists. Efforts are needed to ensure that inner-city children with asthma are receiving guideline-recommended asthma specialty care.
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Affiliation(s)
- Karen L Warman
- a The Children's Hospital at Montefiore , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Ellen J Silver
- a The Children's Hospital at Montefiore , Albert Einstein College of Medicine , Bronx , NY , USA
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Lothrop N, Hussaini K, Billheimer D, Beamer P. Community-level characteristics and environmental factors of child respiratory illnesses in Southern Arizona. BMC Public Health 2017; 17:516. [PMID: 28545417 PMCID: PMC5445507 DOI: 10.1186/s12889-017-4424-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 05/15/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Lower respiratory illnesses (LRIs) and asthma are common diseases in children <5 years of age. Few studies have investigated the relationships between multiple, home-based social and environmental risk factors and asthma and LRIs in children. Of those that have, none have focused exclusively on children <5 years of age, who are more physiologically vulnerable and spend more time at home compared to older children. Further, no studies have done so at the community level. METHODS We modeled relationships between emergency department visits and hospitalization rates for asthma and LRIs for children <5 years and geographic risk factors, including socio-economic and housing characteristics, ambient air pollution levels, and population density in Maricopa and Pima Counties, Arizona, from 2005 to 2009. We used a generalized linear model with a negative binomial observation distribution and an offset for the population of very young children in each tract. To reduce multicollinearity among predictors, socio-economic characteristics, and ambient air pollutant levels were combined into unit-less indices using the principal components analysis (PCA). Housing characteristics variables did not exhibit moderate-to-high correlations and thus were not included in PCA. Spatial autocorrelation among regression model residuals was assessed with the Global Moran's I test. RESULTS Following the regression analyses, almost all predictors were significantly related to at least one disease outcome. Lower socio-economic status (SES) and reduced population density were associated with asthma hospitalization rates and both LRI outcomes (p values <0.001). After adjusting for differences between counties, Pima County residence was associated with lower asthma and LRI hospitalization rates. No spatial autocorrelation was found among multiple regression model residuals (p values >0.05). CONCLUSIONS Our study revealed complex, multi-factorial associations between predictors and outcomes. Findings indicate that many rural areas with lower SES have distinct factors for childhood respiratory diseases that require further investigation. County-wide differences in maternal characteristics or agricultural land uses (not tested here) may also play a role in Pima County residence protecting against hospitalizations, when compared to Maricopa County. By better understanding this and other relationships, more focused public health interventions at the community level could be developed to reduce and better control these diseases in children <5 years, who are more physiologically vulnerable.
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Affiliation(s)
- Nathan Lothrop
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., PO 245210, Tucson, AZ 85724 USA
| | - Khaleel Hussaini
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., PO 245210, Tucson, AZ 85724 USA
- Biomedical Informatics, College of Medicine, University of Arizona, Tucson, AZ 85724 USA
| | - Dean Billheimer
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., PO 245210, Tucson, AZ 85724 USA
- BIO5 Institute, University of Arizona, Tucson, AZ 85724 USA
| | - Paloma Beamer
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., PO 245210, Tucson, AZ 85724 USA
- BIO5 Institute, University of Arizona, Tucson, AZ 85724 USA
- Arizona Respiratory Center, University of Arizona, Tucson, AZ 85724 USA
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Holderness H, Chin N, Ossip DJ, Fagnano M, Reznik M, Halterman JS. Physical activity, restrictions in activity, and body mass index among urban children with persistent asthma. Ann Allergy Asthma Immunol 2017; 118:433-438. [PMID: 28268134 DOI: 10.1016/j.anai.2017.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/21/2016] [Accepted: 01/12/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Asthma and obesity are public health problems that disproportionately affect underserved children. Urban children with asthma may be limited in their participation in physical activity, further increasing their risk for overweight. OBJECTIVE To determine the prevalence of overweight and obesity among high-risk children with persistent asthma, to assess physical activity and activity restrictions by level of asthma control, and to evaluate whether activity is associated with weight status. METHODS We analyzed baseline data from 324 urban children with poorly controlled asthma (3-10 years old) enrolled in the School-Based Telemedicine Enhanced Asthma Management program in Rochester, New York. Caregivers reported their child's asthma symptoms, physical activity, and activity limitation, and height and weight were measured. RESULTS Most children were black (59%), and 69% had Medicaid. Almost half (47%) of children had symptoms that indicated poorly controlled asthma, 15% were overweight, and 31% were obese. Few children (39%) participated in 1 or more hour of physical activity per day. In addition, most (85%) did not walk to and from school, 38% did not have any recess in school, and 35% reported no safe place to exercise. More children with very poorly controlled asthma symptoms, compared with children with more mild symptoms, reported limitation in gym class (58% vs 43%, P = .01) and even in mild activities (28% vs 14%, P = .004). Children with activity limitation were at significantly greater odds of being overweight or obese (odds ratio, 2.1; 95% confidence interval, 1.2-3.8). CONCLUSION Many children with persistent asthma are overweight or obese, have limited opportunity for activity, and experience activity limitations. Efforts are needed to optimize asthma control and provide opportunity for increased physical activity in and outside school. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01650844.
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Affiliation(s)
- Heather Holderness
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
| | - Nancy Chin
- Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, New York
| | - Deborah J Ossip
- Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, New York
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York.
| | - Marina Reznik
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, New York
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
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37
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Wisnivesky JP, Riekert K, Celedón JC. Overview. Respir Med 2017. [DOI: 10.1007/978-3-319-43447-6_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Silber JH, Rosenbaum PR, Calhoun SR, Reiter JG, Hill AS, Guevara JP, Zorc JJ, Even-Shoshan O. Racial Disparities in Medicaid Asthma Hospitalizations. Pediatrics 2017; 139:e20161221. [PMID: 28025238 DOI: 10.1542/peds.2016-1221] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Black children with asthma comprise one-third of all asthma patients in Medicaid. With increasing Medicaid coverage, it has become especially important to monitor Medicaid for differences in hospital practice and patient outcomes by race. METHODS A multivariate matched cohort design, studying 11 079 matched pairs of children in Medicaid (black versus white matched pairs from inside the same state) admitted for asthma between January 1, 2009 and November 30, 2010 in 33 states contributing adequate Medicaid Analytic eXtract claims. RESULTS Ten-day revisit rates were 3.8% in black patients versus 4.2% in white patients (P = .12); 30-day revisit and readmission rates were also not significantly different by race (10.5% in black patients versus 10.8% in white patients; P = .49). Length of stay (LOS) was also similar; both groups had a median stay of 2.0 days, with a slightly lower percentage of black patients exceeding their own state's median LOS (30.2% in black patients versus 31.8% in white patients; P = .01). The mean paired difference in LOS was 0.00 days (95% confidence interval, -0.08 to 0.08). However, ICU use was higher in black patients than white patients (22.2% versus 17.5%; P < .001). After adjusting for multiple testing, only 4 states were found to differ significantly, but only in ICU use, where blacks had higher rates of use. CONCLUSIONS For closely matched black and white patients, racial disparities concerning asthma admission outcomes and style of practice are small and generally nonsignificant, except for ICU use, where we observed higher rates in black patients.
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Affiliation(s)
- Jeffrey H Silber
- Center for Outcomes Research, and
- Departments of Pediatrics
- Anesthesiology and Critical Care, School of Medicine
- Health Care Management, and
- Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul R Rosenbaum
- Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania
- Statistics, The Wharton School, and
| | | | | | | | - James P Guevara
- Departments of Pediatrics
- Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania
- Divisions of General Pediatrics, and
| | - Joseph J Zorc
- Departments of Pediatrics
- Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
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Anarella JP, Wagner VL, McCauley SG, Mane JB, Waniewski PA. Eliminating Disparities in Asthma Care: Identifying Broad Challenges in Quality Improvement. Am J Med Qual 2016; 32:598-604. [PMID: 28693328 DOI: 10.1177/1062860616682587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Racial disparities in asthma care persist in New York State's Medicaid Program. African Americans with asthma experience higher rates of emergency department visits and inpatient hospitalizations, coupled with lower rates of long-term control medication use compared to other racial/ethnic groups. Within this context, and with funding from the Centers for Disease Control and Prevention, the New York State Department of Health designed and implemented the Eliminating Disparities in Asthma Care (EDAC) Collaborative to improve the quality of asthma care delivered in 7 provider sites located in Central Brooklyn, New York. EDAC was a partnership of the New York State Medicaid and Asthma Control Programs, 6 New York City-based managed care plans, and community-based health care providers. Over the 5-year funding period, improvements in documented asthma severity diagnosis and control classification were observed. This article describes the EDAC approach, successes, and challenges.
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Affiliation(s)
- Joseph P Anarella
- 1 Office of Quality and Patient Safety, New York State Department of Health, Albany, NY
| | - Victoria L Wagner
- 1 Office of Quality and Patient Safety, New York State Department of Health, Albany, NY
| | - Susan G McCauley
- 1 Office of Quality and Patient Safety, New York State Department of Health, Albany, NY
| | | | - Patricia A Waniewski
- 3 Bureau of Community Chronic Disease Prevention, New York State Department of Health, Albany, NY
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Abstract
This article reviews the literature on the effects of living in a disenfranchised community for low-income African American children who have asthma. The review focuses on social integration, social network, interactions with parents, and limited cultural resources, which lead to negative health outcomes among these children.
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Affiliation(s)
- Jo A Dowell
- 1 College of Nursing, Kent State University, Kent, OH, USA
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Kolmodin MacDonell K, Naar S, Gibson-Scipio W, Lam P, Secord E. The Detroit Young Adult Asthma Project: Pilot of a Technology-Based Medication Adherence Intervention for African-American Emerging Adults. J Adolesc Health 2016; 59:465-71. [PMID: 27475032 PMCID: PMC5035614 DOI: 10.1016/j.jadohealth.2016.05.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/24/2016] [Accepted: 05/26/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE To conduct a randomized controlled pilot of a multicomponent, technology-based intervention promoting adherence to controller medication in African-American emerging adults with asthma. The intervention consisted of two computer-delivered sessions based on motivational interviewing combined with text messaged reminders between sessions. METHODS Participants (N = 49) were 18-29 years old, African-American, with persistent asthma requiring controller medication. Participants had to report poor medication adherence and asthma control. Youth were randomized to receive the intervention or an attention control. Data were collected through computer-delivered self-report questionnaires at baseline, 1, and 3 months. Ecological Momentary Assessment via two-way text messaging was also used to collect "real-time" data on medication use and asthma control. RESULTS The intervention was feasible and acceptable to the target population, as evidenced by high retention rates and satisfaction scores. Changes in study outcomes from pre- to postintervention favored the intervention, particularly for decrease in asthma symptoms, t (42) = 2.22, p < .05 (Cohen's d = .071). CONCLUSIONS Results suggest that the intervention is feasible and effective. However, findings are preliminary and should be replicated with a larger sample and more sophisticated data analyses.
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Affiliation(s)
- Karen Kolmodin MacDonell
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan.
| | - Sylvie Naar
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Phebe Lam
- University of Windsor, Faculty of Arts, Humanities, and Social Sciences, Windsor, Ontario, Canada
| | - Elizabeth Secord
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
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Makhinova T, Barner JC, Richards KM, Rascati KL. Asthma Controller Medication Adherence, Risk of Exacerbation, and Use of Rescue Agents Among Texas Medicaid Patients with Persistent Asthma. J Manag Care Spec Pharm 2016; 21:1124-32. [PMID: 26679962 PMCID: PMC10401995 DOI: 10.18553/jmcp.2015.21.12.1124] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adherence to asthma long-term controller medications is one of the key drivers to improve asthma management among patients with persistent asthma. While suboptimal use of controller medications has been found to be associated with more frequent use of oral corticosteroids (OCS), few studies exist regarding the relationship between adherence to controller therapy and the use of short-acting beta2-agonists (SABAs). A better understanding of the association between adherence to asthma controller agents and use of reliever medications will help health care providers and decision makers enhance asthma management. OBJECTIVE To determine if there is a relationship between asthma controller adherence, risk of exacerbation requiring OCS, and use of asthma rescue agents. METHODS Texas Medicaid claims data from January 1, 2008, to August 31, 2011, were retrospectively analyzed. Continuously enrolled patients aged 5-63 years with a primary diagnosis of asthma (ICD-9-CM code 493) and with 4 or more prescription claims for any asthma medication in 1 year (persistent asthma) were included. The index date was the date of the first asthma controller prescription, and patients were followed for 1 year. The primary outcome variables were SABA (dichotomous: less than 6 vs. ≥ 6) and OCS (continuous) use. The primary independent variable was adherence (proportion of days covered [PDC]) to asthma long-term controller medications. Covariates included demographics and nonstudy medication utilization. Multivariate logistic and linear regression analyses were employed to address the study objective. RESULTS The study sample (n = 32,172) was aged 15.0 ± 14.5 years, and adherence to controller therapy was 32.2% ± 19.7%. The mean number of SABA claims was 3.7 ± 3.1, with most patients having 1-5 claims (73.2%), whereas 19.4% had ≥ 6 SABA claims. The mean number of OCS claims was 1.0 ± 1.4. Adherent (PDC ≥ 50%) patients were 96.7% (OR = 1.967; 95% CI = 1.826-2.120) more likely to have ≥ 6 SABA claims when compared with nonadherent (PDC less than 50%) patients (P less than 0.001). As for OCS use, adherent patients had 0.11 fewer claims compared with nonadherent patients (P less than 0.001). Importantly, patients with ≥ 6 SABA claims had 0.7 more OCS claims compared with patients with less than 6 claims for SABA (P less than 0.001). The odds of having ≥ 6 SABA claims were higher for concurrent dual therapy users, older age, males, African Americans and higher number of nonstudy medications (P less than 0.001). Dual therapy users, younger age, Hispanic ethnicity, and higher number of nonstudy medications were associated with an increase in OCS use (P less than 0.005). CONCLUSIONS Adherence to long-term controller medications was suboptimal among patients with asthma. Adherent patients had fewer OCS claims, indicating that adherence to controller therapy is critical in preventing asthma exacerbations requiring OCS use. Although there was a positive relationship between adherence to long-term controller medication and SABA use, increased SABA use served as a predictor of increased OCS use, which indicates poor asthma control. Health care providers should be aware of OCS and SABA use among patients who are both adherent and nonadherent to asthma controller medications.
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Affiliation(s)
- Tatiana Makhinova
- The University of Texas at Austin, 2409 University Ave., STOP A1930, Austin, TX 78712-1120.
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Glick AF, Tomopoulos S, Fierman AH, Trasande L. Disparities in Mortality and Morbidity in Pediatric Asthma Hospitalizations, 2007 to 2011. Acad Pediatr 2016; 16:430-437. [PMID: 26768727 PMCID: PMC10843839 DOI: 10.1016/j.acap.2015.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/27/2015] [Accepted: 12/30/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Asthma is a leading cause of pediatric admissions. Although several factors including race have been linked to increased overall asthma morbidity and mortality, few studies have explored factors associated with inpatient asthma outcomes. We examined factors associated with mortality and morbidity in children admitted for asthma. METHODS Data were obtained from the US Nationwide Inpatient Sample for 2007 to 2011. Patients 2 to 18 years old with a primary diagnosis of asthma were included. Predictor variables were sociodemographic and hospital factors and acute/chronic secondary diagnoses. Outcomes were mortality, intubation, length of stay (LOS), and costs. Weighted national estimates were calculated. Multivariable analyses were performed. RESULTS There were 97,379 (478,546 weighted) asthma admissions. Most patients were male (60.6%); 30% were white, 28% black, and 18% Hispanic. Mortality rate was 0.03%, and 0.3% were intubated. Median LOS was 2 (interquartile range, 1-3) days. Median costs were $2,950 (interquartile range, $1990-$4610). Native American race, older age (13-18 years), and West region were significant independent predictors of mortality. Intubation rate was lower in Hispanic compared with white children (P = .028). LOS was shorter in Asian compared with white children (P = .022) but longer in children with public insurance and from low income areas (P < .001). Average costs were higher in black, Hispanic, and Asian compared with white children (P < .05). CONCLUSIONS With the exception of Native Americans, race/ethnicity is not associated with inpatient asthma mortality and has varied effects on morbidity. Recognition of factors associated with increased asthma mortality and morbidity might allow for earlier, more effective treatment and avoidance of complications.
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Affiliation(s)
- Alexander F Glick
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York.
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York
| | - Arthur H Fierman
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York
| | - Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York; Departments of Environmental Medicine and Population Health, New York University School of Medicine, New York; New York University Wagner School of Public Service, New York; Department of Nutrition, Food & Public Health, New York University Steinhardt School of Culture, Education, and Human Development, New York; New York University Global Institute of Public Health, New York
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Abstract
There is overwhelming evidence that disparities in the provision of health care exist between various groups of people. Pharmacists must be aware of these disparities and join the health workforce in closing the gap between people of different racial, ethnic, and cultural backgrounds. The role of the pharmacist has expanded, and this profession must embrace diversity to provide a higher quality of care to all patients. Cultural competence in health care is an ongoing process and starts with self-reflection. It incorporates the ability to recognize the unique needs of diverse gpopulations and the ability to adapt care accordingly. In addition to knowledge and skills, cultural competence requires a positive attitude that emphasizes respect across all cultures. While pharmacists have often lacked training in caring for diverse patients, learning a few basic concepts will assist them with their individual patient encounters. This article provides essential elements that will help pharmacists better understand cultural competence and apply this knowledge in pharmacy practice.
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Affiliation(s)
- Oralia V. Bazaldua
- University of Texas Health Science Center at San Antonio, Department of Family and Community Medicine, 7703 Floyd Curl Drive, San Antonio, Texas 78229
| | - Jeri Sias
- University of Texas/El Paso and Austin, Cooperative Pharmacy Program, 1100 N. Stanton, Suite 301, El Paso, TX 79902
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Simpson L, Dougherty D, Krause D, Ku CM, Perrin JM. Measuring Children's Health Care Quality. Am J Med Qual 2016; 22:80-4. [PMID: 17395962 DOI: 10.1177/1062860606298549] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lisa Simpson
- Child Policy Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. lisa
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Yinusa-Nyahkoon L, Cohn ES, Tickle-Degnen L, Cortés DE, Lieu TA, Bokhour BG. Examining Routines to Understand the Ecological Context: Managing Childhood Asthma. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016. [DOI: 10.1177/15394492070270s121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baltrus P, Xu J, Immergluck L, Gaglioti A, Adesokan A, Rust G. Individual and county level predictors of asthma related emergency department visits among children on Medicaid: A multilevel approach. J Asthma 2016; 54:53-61. [PMID: 27285734 DOI: 10.1080/02770903.2016.1196367] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Disparities in asthma outcomes are well documented in the United States. Interventions to promote equity in asthma outcomes could target factors at the individual and community levels. The objective of this analysis was to understand the effect of individual (race, gender, age, and preventive inhaler use) and county-level factors (demographic, socioeconomic, health care, air-quality) on asthma emergency department (ED) visits among Medicaid-enrolled children. This was a retrospective cohort study of Medicaid-enrolled children with asthma in 29 states in 2009. Multilevel regression models of asthma ED visits were constructed utilizing individual-level variables (race, gender, age, and preventive inhaler use) from the Medicaid enrollment file and county-level variables reflecting population and health system characteristics from the Area Resource File (ARF). County-level measures of air quality were obtained from Environmental Protection Agency (EPA) data. RESULTS The primary modifiable risk factor at the individual level was found to be the ratio of long-term controller medications to total asthma medications. County-level factors accounted for roughly 6% of the variance in the asthma ED visit risk. Increasing county-level racial segregation (OR=1.04, 95% CI=1.01-1.08) was associated with increasing risk of asthma ED visits. Greater supply of pulmonary physicians at the county level (OR=0.81, 95% CI=0.68-0.97) was associated with a reduction in risk of asthma ED visits. CONCLUSIONS At the patient care level, proper use of controller medications is the factor most amenable to intervention. There is also a societal imperative to address negative social determinants, such as residential segregation.
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Affiliation(s)
- Peter Baltrus
- a National Center for Primary Care, Morehouse School of Medicine , Atlanta , GA , USA.,b Department of Community Health & Preventive Medicine , Morehouse School of Medicine , Atlanta , GA , USA
| | - Junjun Xu
- a National Center for Primary Care, Morehouse School of Medicine , Atlanta , GA , USA
| | - Lilly Immergluck
- a National Center for Primary Care, Morehouse School of Medicine , Atlanta , GA , USA.,c Departments of Microbiology , Biochemistry, & Immunology and Pediatrics, Morehouse School of Medicine , Atlanta , GA , USA
| | - Anne Gaglioti
- a National Center for Primary Care, Morehouse School of Medicine , Atlanta , GA , USA.,d Department of Family Medicine , Morehouse School of Medicine , Atlanta , GA , USA
| | - Adeola Adesokan
- e Master of Science in Clinical Research Program, Morehouse School of Medicine , Atlanta , GA , USA
| | - George Rust
- a National Center for Primary Care, Morehouse School of Medicine , Atlanta , GA , USA.,d Department of Family Medicine , Morehouse School of Medicine , Atlanta , GA , USA
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Wu AC, Li L, Fung V, Kharbanda EO, Larkin EK, Butler MG, Galbraith A, Miroshnik I, Davis RL, Horan K, Lieu TA. Mismatching Among Guidelines, Providers, and Parents on Controller Medication Use in Children with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:910-6. [PMID: 27212379 DOI: 10.1016/j.jaip.2016.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Underuse of controller medicines among children with asthma remains widespread despite national guidelines. OBJECTIVES To (1) assess provider prescribing patterns for asthma controller medications; (2) assess how frequently parents' reports of their child's asthma controller medicine use were mismatched with their provider's recommendations; and (3) evaluate parent attitudes and demographic characteristics associated with these mismatches. METHODS In this cross-sectional study, we conducted linked surveys of parents and providers of children with probable persistent asthma in a Medicaid program and 4 commercial health plans in 2011. Probable persistent asthma was defined as a diagnosis of asthma and 1 or more controller medication dispensing. RESULTS This study included 740 children (mean age, 8.6 years). Providers for 50% of the children reported prescribing controller medications for daily year-round use, 41% for daily use during active asthma months, and 9% for intermittent use for relief. Among parents, 72% knew which class of controller medication the provider prescribed and 49% knew the administration frequency and the medication class. Parents were less likely to report the same controller medication type as the provider, irrespective of dose and frequency, if they were Latino (odds ratio [OR], 0.23; CI, 0.057-0.90), had a household smoker (OR, 2.87; CI, 0.42-19.6), or believed the controller medicine was not helping (OR, 0.15; CI, 0.048-0.45). CONCLUSIONS Mismatches between parent reports and providers intentions regarding how the child was supposed to use inhaled steroids occurred for half of the children. Efforts should focus on ways to reduce mismatches between parent and provider intentions regarding controller medication use.
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Affiliation(s)
- Ann Chen Wu
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Lingling Li
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Vicki Fung
- Harvard Medical School, Boston, Mass; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Mass
| | - Elyse O Kharbanda
- HealthPartners Institute for Education and Research, Minneapolis, Minn
| | - Emma K Larkin
- Vanderbilt University School of Medicine, Nashville, Tenn
| | - Melissa G Butler
- Center for Clinical Outcomes & Research - Southeast, Kaiser Permanente Georgia, Atlanta, Ga; The Argus Group, Hamilton, Bermuda
| | - Alison Galbraith
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Boston, Mass
| | - Irina Miroshnik
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Robert L Davis
- Center for Biomedical Informatics, University of Tennessee Health Sciences Center, Memphis, Tenn
| | - Kelly Horan
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Tracy A Lieu
- Division of Research, Kaiser Permanente Northern California, Oakland, Calif
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Pardue Jones B, Fleming GM, Otillio JK, Asokan I, Arnold DH. Pediatric acute asthma exacerbations: Evaluation and management from emergency department to intensive care unit. J Asthma 2016; 53:607-17. [PMID: 27116362 DOI: 10.3109/02770903.2015.1067323] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The goal of this report is to review available modalities for assessing and managing acute asthma exacerbations in pediatric patients, including some that are not included in current expert panel guidelines. While it is not our purpose to provide a comprehensive review of the National Asthma Education and Prevention Program (NAEPP) guidelines, we review NAEPP-recommended treatments to provide the full range of treatments available for managing exacerbations with an emphasis on the continuum of care between the ER and ICU. DATA SOURCES We searched PubMed using the following search terms in different combinations: asthma, children, pediatric, exacerbation, epidemiology, pathophysiology, guidelines, treatment, management, oxygen, albuterol, β2-agonist, anticholinergic, theophylline, corticosteroid, magnesium, heliox, BiPAP, ventilation, mechanical ventilation, non-invasive mechanical ventilation and respiratory failure. We attempted to weigh the evidence using the hierarchy in which meta-analyses of randomized controlled trials (RCTs) provide the strongest evidence, followed by individual RCTs, followed by observational studies. We also reviewed the NAEPP and Global Initiative for Asthma expert panel guidelines. RESULTS AND CONCLUSIONS Asthma is the most common chronic disease of childhood, and acute exacerbations are a significant burden to patients and to public health. Optimal assessment and management of exacerbations, including appropriate escalation of interventions, are essential to minimize morbidity and prevent mortality. While inhaled albuterol and systemic corticosteroids are the mainstay of exacerbation management, escalation may include interventions discussed in this review.
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Affiliation(s)
| | | | | | | | - Donald H Arnold
- a Department of Pediatrics , Division of Emergency Medicine.,d Center for Asthma Research, Vanderbilt University School of Medicine , Nashville , TN , USA
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Chan AHY, Stewart AW, Foster JM, Mitchell EA, Camargo CA, Harrison J. Factors associated with medication adherence in school-aged children with asthma. ERJ Open Res 2016; 2:00087-2015. [PMID: 27730181 PMCID: PMC5005164 DOI: 10.1183/23120541.00087-2015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/28/2016] [Indexed: 11/23/2022] Open
Abstract
Adherence to preventive asthma treatment is poor, particularly in children, yet the factors associated with adherence in this age group are not well understood. Adherence was monitored electronically over 6 months in school-aged children who attended a regional emergency department in New Zealand for an asthma exacerbation and were prescribed twice-daily inhaled corticosteroids. Participants completed questionnaires including assessment of family demographics, asthma responsibility and learning style. Multivariable analysis of factors associated with adherence was conducted. 101 children (mean (range) age 8.9 (6–15) years, 51% male) participated. Median (interquartile range) preventer adherence was 30% (17–48%) of prescribed. Four explanatory factors were identified: female sex (+12% adherence), Asian ethnicity (+19% adherence), living in a smaller household (−3.0% adherence per person in the household), and younger age at diagnosis (+2.7% for every younger year of diagnosis) (all p<0.02). In school-aged children attending the emergency department for asthma, males and non-Asian ethnic groups were at high risk for poor inhaled corticosteroid adherence and may benefit most from intervention. Four factors explained a small proportion of adherence behaviour indicating the difficulty in identifying adherence barriers. Further research is recommended in other similar populations. Girls, children of Asian ethnicity, small household size and younger diagnosis age have better adherence to asthmahttp://ow.ly/Z1y6Q
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Affiliation(s)
- Amy H Y Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Alistair W Stewart
- Epidemiology & Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Juliet M Foster
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Edwin A Mitchell
- Dept of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Carlos A Camargo
- Dept of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeff Harrison
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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