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Dikranian LC, Irish DE, Shanley KE, Walker DR, de Waal Malefyt SK. Improving asthma self-management education through inhaler labeling. PEC INNOVATION 2024; 5:100330. [PMID: 39252880 PMCID: PMC11381901 DOI: 10.1016/j.pecinn.2024.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 07/15/2024] [Accepted: 08/03/2024] [Indexed: 09/11/2024]
Abstract
Objective Improper use and poor understanding of asthma medications can lead to poorly controlled asthma, emergency department visits, and hospitalizations for children with asthma. Pharmacists play a critical role in improving asthma medication adherence through education on asthma self-management. The use of color-coded labels applied at pharmacies to help patients differentiate between rescue and maintenance inhalers has not been explored. Methods Pharmacies were recruited to join a community pharmacy asthma coalition. Pharmacists provided patient education and labeled inhalers with two types of color-coded stickers. A red sticker labeled "RESCUE" was used for short-acting β-2 agonist medication inhalers. A green sticker labeled "USE EVERY DAY" was used for inhaled corticosteroids (ICS) or combination ICS/long-acting β-2 agonist medication inhalers. Results During the two years of the pilot program, 25 pharmacy locations participated. Pharmacies labeled over 6000 rescue and 9000 controller medications using color-coded labels. Over 1000 children and 7000 adults were served by the coalition. Conclusion Color-coded asthma medication labels can be successfully utilized by pharmacies. This low-cost tool provides vital information regarding the proper use of asthma medications. Innovation The color-coded labeling of asthma medications is a novel innovation that can be successfully used by pharmacists to improve asthma self-management education.
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Affiliation(s)
- Lea C Dikranian
- Children's Hospital of Michigan, Detroit, MI, United States of America
| | | | | | - Don R Walker
- University of Las Vegas, Las Vegas, NV, United States of America
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2
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Mackle R, Chan M, Lay M, Purcell M, Campbell N, Jaffe A, Owens L, Gray M, Homaira N. Parental Perceptions and Knowledge towards Asthma Action Plans. J Asthma 2024:1-15. [PMID: 39330958 DOI: 10.1080/02770903.2024.2408758] [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: 05/29/2024] [Revised: 09/10/2024] [Accepted: 09/21/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION Personalised Asthma Action Plans (AAPs) are a cornerstone of paediatric asthma management. We aimed to assess parental knowledge and perceptions of the use of AAPs in managing their child's asthma. METHODS In 2023 we conducted a cross-sectional survey to assess knowledge and perceptions of AAPs in parents/caregivers of children aged 0-17 years with asthma who had an AAP and attended respiratory clinics at Sydney Children's Hospital, Randwick. The questionnaire included parental perceptions on the utility of AAPs, parental asthma management self-efficacy (PAMSE), and an adapted version of the Asthma Action Plan Knowledge Interview tool (AAPKI). Descriptive statistics and regression analyses were used to assess associations between AAPKI, PAMSE and other outcomes. RESULTS Seventy-one parents completed the survey. Mean PAMSE score was 4.2/5 (SD 0.5). Median AAPKI score was 70.2% out of 100% (IQR 20.4%). Most parents (80.0%, n = 56) were satisfied/very satisfied with using AAPs to manage their child's asthma. Most agreed/strongly agreed that AAPs were helpful in knowing when to seek medical attention for their child's asthma (81.7%, n = 58), helped their understanding of asthma severity (81.7%, n = 58), and increased their confidence in asthma management (76.0%, n = 54). Over half of parents (55.7%, n = 39) would prefer AAPs digitally and majority (78.6%, n = 55) would like colour-coded AAPs. CONCLUSION High levels of AAP knowledge and self-efficacy scores were demonstrated. Most parents expressed understanding of the benefits of AAPs. Our findings suggest parents of children with asthma prefer AAPs in colour and in digital version which may help guide standardisation of AAPs across Australia.
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Affiliation(s)
- Ryan Mackle
- Respiratory Department, Sydney Children's Hospital Randwick, Sydney Children's Hospital Network, NSW, Australia
- Discipline of Paediatrics and Child Health, Faculty of Medicine, UNSW Sydney, NSW, Australia
| | - Mei Chan
- Discipline of Paediatrics and Child Health, Faculty of Medicine, UNSW Sydney, NSW, Australia
| | - Monica Lay
- Discipline of Paediatrics and Child Health, Faculty of Medicine, UNSW Sydney, NSW, Australia
| | - Michael Purcell
- Respiratory Department, Sydney Children's Hospital Randwick, Sydney Children's Hospital Network, NSW, Australia
| | - Nicole Campbell
- Respiratory Department, Sydney Children's Hospital Randwick, Sydney Children's Hospital Network, NSW, Australia
| | - Adam Jaffe
- Respiratory Department, Sydney Children's Hospital Randwick, Sydney Children's Hospital Network, NSW, Australia
- Discipline of Paediatrics and Child Health, Faculty of Medicine, UNSW Sydney, NSW, Australia
| | - Louisa Owens
- Respiratory Department, Sydney Children's Hospital Randwick, Sydney Children's Hospital Network, NSW, Australia
- Discipline of Paediatrics and Child Health, Faculty of Medicine, UNSW Sydney, NSW, Australia
| | - Melinda Gray
- Respiratory Department, Sydney Children's Hospital Randwick, Sydney Children's Hospital Network, NSW, Australia
| | - Nusrat Homaira
- Respiratory Department, Sydney Children's Hospital Randwick, Sydney Children's Hospital Network, NSW, Australia
- Discipline of Paediatrics and Child Health, Faculty of Medicine, UNSW Sydney, NSW, Australia
- James P. Grant School of Public Health, BRAC University, Bangladesh
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Ferreira-Alfaya FJ, Zarzuelo-Romero MJ, Cura Y. Pharmaceutical pictograms to improve textual comprehension: A systematic review. Res Social Adm Pharm 2024; 20:75-85. [PMID: 38030546 DOI: 10.1016/j.sapharm.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Written instructive information for the patient is key in pharmaceutical care. However, the preexisting literature agrees on the discordance between the readability of written medication messages intended for patients. The aim of our work was to systematically review the available evidence on the effect of pharmaceutical pictograms as elements that facilitate understanding of the text in primary or secondary medication packaging. METHODS A parallel systematic search was conducted of the literature covering evidence of the effect of including pictograms in primary or secondary packaging on comprehension by potential users or caregivers up to April 9, 2023. The databases consulted were Scopus, MEDLINE and Web of Science. Only randomized controlled studies, whose main outcome measure was comprehension, were included. RESULTS Only 8 papers met our search criteria. In most of the included studies, the intervention of including pictograms improved participants' performance in comprehending instructions. A debatable methodological quality, and differences in the target population, textual complexity of the materials or the cultural affinity of the pictograms with the target population in each study, could have had a decisive influence on the results. CONCLUSION The heterogeneity in the design of each study poses a significant barrier to establishing commonalities and generalizing the results. This heterogeneity also prevented us from conclusively confirming the usefulness of pictograms complementary to instructional text in improving the comprehension of instructions for the rational use of medicines.
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Affiliation(s)
| | | | - Yasmin Cura
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Spain
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Glick AF, Farkas JS, Gadhavi J, Mendelsohn AL, Schulick N, Yin HS. Pediatric Resident Communication of Hospital Discharge Instructions. Health Lit Res Pract 2023; 7:e178-e186. [PMID: 37812910 PMCID: PMC10561625 DOI: 10.3928/24748307-20230918-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/18/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE Suboptimal provider-parent communication contributes to poor parent comprehension of pediatric discharge instructions, which can lead to adverse outcomes. Residency is a critical window to acquire and learn to utilize key communication skills, potentially supported by formal training programs or visual reminders. Few studies have examined resident counseling practices or predictors of counseling quality. Our objectives were to (1) examine pediatric resident counseling practices and (2) determine how formal training and presence of discharge templates with domain-specific prompts are associated with counseling. METHODS We conducted a cross-sectional survey of a convenience sample of residents in the American Academy of Pediatrics Section on Pediatric Trainees. Outcomes included resident self-report of frequency of (1) counseling in domains of care and (2) use of health literacy-informed counseling strategies (pictures, demonstration, Teach Back, Show Back) (6-point scales; frequent = often/usually/always). Predictor variables were (1) formal discharge-related training (e.g., lectures) and (2) hospital discharge instruction template with space for individual domains. Logistic regression analyses, utilizing generalized estimating equations when appropriate to account for multiple domains (adjusting for resident gender, postgraduate year), were performed. KEY RESULTS Few residents (N = 317) (13.9%) reported formal training. Over 25% of residents infrequently counsel on side effects, diagnosis, and restrictions. Resident reported use of communication strategies was infrequent: drawing pictures (24.1%), demonstration (15.8%), Teach Back (36.8%), Show Back (11.4%). Designated spaces in instruction templates for individual domains were associated with frequent domain-specific counseling (adjusted odds ratio [aOR] 4.1 [95% confidence interval: 3.5-4.8]). Formal training was associated with frequent Teach Back (aOR 2.6 [1.4-5.1]) and Show Back (aOR 2.7 [1.2-6.2]). CONCLUSIONS Lack of formal training and designated space for domain-specific instructions are associated with suboptimal counseling at discharge by pediatric residents. Future research should focus on determining the best mechanisms for teaching trainees communication skills and optimizing written instruction templates to support verbal counseling. [HLRP: Health Literacy Research and Practice. 2023;7(4):e178-e186.].
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Affiliation(s)
- Alexander F. Glick
- Address correspondence to Alexander F. Glick, MD, MS, Department of Pediatrics, NYU Grossman School of Medicine/Bellevue Hospital Center, 462 First Avenue, New York, NY 10016;
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Kaplan C, Kranidis A, Saint-Fleur AL, Christophides A, Kier C. Bridging the Gap from Acute to Chronic Care: Partnerships and Tools for Pediatric Asthma. Pediatr Rev 2023; 44:578-584. [PMID: 37777653 DOI: 10.1542/pir.2022-005599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Carl Kaplan
- Stony Brook Children's Hospital, Stony Brook, NY
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6
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Ho CCY, Chan CWH, Li C, Xiao J, Ng MSN. Literature review and development of pictorial action plan to promote self-management of chronic obstructive pulmonary disease. PATIENT EDUCATION AND COUNSELING 2023; 115:107923. [PMID: 37494782 DOI: 10.1016/j.pec.2023.107923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This study aimed to review relevant literature and develop a pictorial action plan (PAP) to enhance self-management among older patients with chronic obstructive pulmonary disease (COPD). METHODS In Stage 1, an integrative review was conducted to identify key elements of respiratory self-management action plans. In Stage 2, cartoon pictograms with plain descriptions were designed. In Stage 3, the PAP was validated by 40 older patients with COPD and an expert panel. RESULTS While the eight included studies demonstrated positive effects on knowledge and quality of life, key elements identified included: traffic light motif, plain and explicit language, and several action plan topics. The final PAP comprises three traffic light-coloured zones and 24 pictograms that introduce self-management strategies for normal, decreasing, and severely decreased airflow. After revising the cartoon characters, all of the pictograms received guessability ratings above 70% and acceptable mean translucency ratings. DISCUSSION The integrative review provides evidence about the effectiveness and key elements of PAPs. The PAP developed was found to be valid and feasible for use among older patients with chronic respiratory conditions. PRACTICE IMPLICATIONS This study offered an example of translating evidence into patient education practice to enhance self-management in older patients with COPD.
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Affiliation(s)
- Cherry C Y Ho
- Division of Nursing Education, School of Continuing Education, The Hong Kong Baptist University, Hong Kong, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Caixia Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Jinnan Xiao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Marques S N Ng
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
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Stewart TA, Perrin EM, Yin HS. Addressing Health Literacy in Pediatric Practice: A Health Equity Lens. Pediatr Clin North Am 2023; 70:745-760. [PMID: 37422312 DOI: 10.1016/j.pcl.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Low health literacy has been linked to worse child health-related knowledge, behaviors, and outcomes across multiple health domains. As low health literacy is highly prevalent and an important mediator of income- and race/ethnicity-associated disparities, provider adoption of health literacy best practices advances health equity. A multidisciplinary effort involving all providers engaged in communication with families should include a universal precautions approach, with clear communication strategies employed with all patients, and advocacy for health system change.
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Affiliation(s)
- Tiffany A Stewart
- Department of Pediatrics, New York University Grossman School of Medicine / Bellevue Hospital Center, 550 First Avenue, NBV 8S4-11, New York, NY 10016, USA
| | - Eliana M Perrin
- Department of Pediatrics, Johns Hopkins School of Medicine / School of Nursing, 200 North Wolfe Street, Rubenstein Building 2071, Baltimore, MD 21287, USA
| | - Hsiang Shonna Yin
- Department of Pediatrics, New York University Grossman School of Medicine / Bellevue Hospital Center, 550 First Avenue, NBV 8S4-11, New York, NY 10016, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
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8
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Md Khairi LNH, Gnanasan S. Emerging Roles of Malaysian Pharmacists in Asthma Management Amidst the COVID-19 Pandemic: A Narrative Review. Malays J Med Sci 2023; 30:33-47. [PMID: 37655143 PMCID: PMC10467601 DOI: 10.21315/mjms2023.30.4.4] [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: 11/29/2021] [Accepted: 03/01/2022] [Indexed: 09/02/2023] Open
Abstract
The arrival of COVID-19 pandemic in March 2020 adversely affected every aspect of human life, including the management of asthma. The pandemic has forced clinicians to revisit the application of high-risk aerosol-generating procedures in asthma management, including spirometry and nebuliser therapy. The use of commercial spacers with pressurised metered-dose inhalers to replace nebulisation is limited by the high cost and pandemic-induced stock unavailability of these inhalers. The need for social distancing, healthcare reserves reallocation, and scarce personal protective equipment has promote increased telemedicine uptake for patients' asthma control and monitoring. Malaysian pharmacists have been providing long-term care of asthma through the introduction of the respiratory Medication Therapy Adherence Clinic (MTAC) to empower patients' general health literacy, train and regularly evaluate their inhalation technique, and reinforce the importance of medication compliance. To minimise the use of unplanned healthcare resources and avoidable COVID-19 infection exposure, Malaysian pharmacists need to better support asthma self-management via increased uptake of written Asthma Action Plans (AAPs). Pharmacist-led asthma treatment step-down to attain the lowest effective dose of inhaled corticosteroids (ICS) has become increasingly relevant during the pandemic, as its prolonged use carries risk of numerous side effects and possible hospitalisation. Telepharmacy offers a promising model for exploration and an alternative to the traditional service delivery of asthma education. Despite not being authorised as vaccinators, Malaysian pharmacists hold strong positions in COVID-19 immunisation programmes for pharmacovigilance and advocacy. The pandemic demands an increased role for pharmacists within medication management to prevent patients from the stockpiling that can cause adverse effects on pharmaceutical supply chain. This review intends to summarise the impact of COVID-19 on asthma management, with a focus on the transitional roles of Malaysian pharmacists before and after the pandemic era.
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Affiliation(s)
- Lukman Nul Hakim Md Khairi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti Teknologi MARA, Selangor, Malaysia
- Department of Pharmacy, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Terengganu, Malaysia
| | - Shubashini Gnanasan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti Teknologi MARA, Selangor, Malaysia
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9
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Hovey SW, Cho HJ, Kain C, Sauer HE, Smith CJ, Thomas CA. Pharmacist-Led Discharge Transitions of Care Interventions for Pediatric Patients: A Narrative Review. J Pediatr Pharmacol Ther 2023; 28:180-191. [PMID: 37303760 PMCID: PMC10249976 DOI: 10.5863/1551-6776-28.3.180] [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: 03/23/2022] [Accepted: 06/28/2022] [Indexed: 06/13/2023]
Abstract
Transitions of care (TOC) before, during, and after hospital discharge are an opportune setting to optimize medication management. The quality standards for pediatric care transitions, however, are lacking, leading to reduced health outcomes in children. This narrative review characterizes the pediatric populations that would benefit from focused, TOC interventions. Different types of medication-focused TOC interventions during hospital discharge are described, including medication reconciliation, education, access, and adherence tools. Various TOC intervention delivery models following hospital discharge are also reviewed. The goal of this narrative review is to help pediatric pharmacists and pharmacy leaders better understand TOC interventions and integrate them into the hospital discharge process for children and their caregivers.
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Affiliation(s)
- Sara W. Hovey
- Department of Pharmacy Practice (SWH), University of Illinois at Chicago, College of Pharmacy, Chicago, IL
| | - Hae Jin Cho
- Department of Pharmacotherapy (HJC), College of Pharmacy, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX
| | - Courtney Kain
- Department of Pharmacy (CK), Nemours Children's Hospital, Wilmington, DE
| | - Hannah E. Sauer
- Department of Pharmacy (HES), Texas Children's Hospital, Houston, TX
| | - Christina J. Smith
- Department of Pharmacy (CJS), Loma Linda University Children's Hospital, Loma Linda, CA
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10
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Reeves PT, Kenny TM, Mulreany LT, McCown MY, Jacknewitz-Woolard JE, Rogers PL, Echelmeyer S, Welsh SK. Development and assessment of a low literacy, pictographic asthma action plan with clinical automation to enhance guideline-concordant care for children with asthma. J Asthma 2023; 60:655-672. [PMID: 35658804 DOI: 10.1080/02770903.2022.2087188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Asthma is characterized by reversible pulmonary symptoms, frequent hospitalizations, poor quality of life, and varied treatment. Parents with low health literacy (HL) is linked to poor asthma outcomes in children. Recent practice updates recommended inhaled corticosteroids for the management of persistent asthma, but guideline-concordant care is suboptimal. Our aim was to develop and assess an Asthma Action Plan (AAP) that could serve as an individualized plan for low HL families and facilitate guideline-concordant care for clinicians. METHODS We followed the National Institute of Health 5-step "Clear & Simple" approach to develop the Uniformed Services AAP. Our AAP included symptom pictographs (dyspnea, cough, sleep, activity) and guideline-concordant clinical automation tools. Caregivers assessed the pictograms for validity (transparency of ≥ 85%; translucency score ≥ 5; and ≥ 85% recall). Readability was assessed using 7 formulas. (<6th Grade was acceptable). Comprehensibility, design quality, and usefulness was assessed by caregivers using the Consumer Information Rating Form (CIRF) (>80% was acceptable). Understandability and actionability was assessed by medical librarians using the Patient Education Materials Assessment Tool-Printable (>80% was acceptable). Suitability was assessed by clinicians using the modified Suitability Assessment of Materials (SAM) instrument (>70% was superior). RESULTS All 12 pictograms were validated (N = 118 respondents). Readability demonstrated a 4th grade level. Overall CIRF percentile score = 80.4%. Understandability and Actionability = 100%. Suitability score = 75%. CONCLUSIONS Our AAP was formally endorsed by the Allergy & Asthma Network. The Uniformed Services AAP is a novel tool with embedded clinical automation that can address low HL and enhance guideline-concordant care.
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Affiliation(s)
- Patrick T Reeves
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Department of Pediatrics, Division of Pulmonology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Timothy M Kenny
- Department of Pediatrics, Division of Pulmonology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Laura T Mulreany
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael Y McCown
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jane E Jacknewitz-Woolard
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Philip L Rogers
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sofia Echelmeyer
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sebastian K Welsh
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Department of Pediatrics, Division of Pulmonology, Brooke Army Medical Center, San Antonio, TX, USA
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Kaplan C, Saint-Fleur AL, Kranidis AM, Christophides AH, Kier C. Quality improvement for paediatric asthma care in acute settings. Curr Opin Pediatr 2023; 35:281-287. [PMID: 36749141 DOI: 10.1097/mop.0000000000001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW This is a summative review of recent trends and novel programming integrated into various clinical settings (i.e. emergency departments, urgent care centres and paediatric clinics) to enhance the quality of care received by paediatric asthma patients Asthma is the most common chronic disease in paediatric patients and despite recognized national management guidelines, implementation and aftercare, especially in the emergency room, remain challenging. RECENT FINDINGS Outcome-based systematic quality improvement initiatives are described as well as evidence-based recommendations to enhance the education of providers, patients and caregivers. SUMMARY Many of the care initiatives described in the literature have been integrated into the emergency room. The authors feel some of these process improvements, such as pathway-based care, reducing time to delivery of medications, and personalized asthma education, may also be applicable and add value to clinical practice in additional community-based acute care settings such as urgent care centers and paediatric clinics.
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Affiliation(s)
- Carl Kaplan
- Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, New York
| | - Ashley L Saint-Fleur
- Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, New York
| | | | | | - Catherine Kier
- Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, New York
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Hovey SW, Misic M, Jacobson JL, Click KW. Effect of a Pharmacist-Led Discharge Counseling Service at a Children's Hospital. J Pediatr Pharmacol Ther 2023; 28:116-122. [PMID: 37139249 PMCID: PMC10150907 DOI: 10.5863/1551-6776-28.2.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 02/05/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To evaluate the effect of a pharmacist-led discharge counseling service at a pediatric hospital. METHODS This was a prospective observational cohort study. Patients in the pre-implementation phase were identified by the pharmacist at the time of admission medication reconciliation, whereas patients in the pos-timplementation phase were identified at the time of pharmacist discharge medication counselling. Caregivers were contacted within 2 weeks of the patients' discharge date to complete a 7-question telephone survey. The primary objective was to measure the effect of the pharmacist-led service on caregiver satisfaction, using a pre- and post- implementation telephone survey. The secondary objectives were to evaluate the effect of the service on 90-day medication-related readmissions and determine the change in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey response (Question 25) regarding discharge medications following implementation of the new service. RESULTS A total of 32 caregivers were included in both the pre- and post-implementation groups. The most common reason for inclusion was high-risk medications (84%) in the pre-implementation group and device teaching (62.5%) in the post-implementation group. The primary outcome, the average composite score on the telephone survey, was 30.94 ± 3.50 (average ± SD) in the pre-implementation group and 32.5 ± 2.26 in the post-implementation group (p = 0.038). There were no medication-related readmissions within 90 days in either group. The score on HCAHPS Question 25 was not different between groups (p = 0.761). CONCLUSIONS Implementation of a pharmacist-led discharge counseling service in pediatric patients improved caregiver satisfaction and understanding as shown by a postdischarge telephone survey.
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Affiliation(s)
- Sara W. Hovey
- Department of Pharmacy (SWH, MM, JLJ, KWC), Rush University Medical Center, Rush Children's Hospital, Chicago, IL
- Department of Pharmacy Practice (SWH), University of Illinois at Chicago, College of Pharmacy, Chicago, IL
| | - Milica Misic
- Department of Pharmacy (SWH, MM, JLJ, KWC), Rush University Medical Center, Rush Children's Hospital, Chicago, IL
| | - Jessica L. Jacobson
- Department of Pharmacy (SWH, MM, JLJ, KWC), Rush University Medical Center, Rush Children's Hospital, Chicago, IL
| | - Kristen W. Click
- Department of Pharmacy (SWH, MM, JLJ, KWC), Rush University Medical Center, Rush Children's Hospital, Chicago, IL
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Samady W, Rodriguez VA, Gupta R, Palac H, Pongracic JA, Press VG. Interactive Inpatient Asthma Education: A Randomized Controlled Trial. Hosp Pediatr 2022; 12:239-247. [PMID: 35190827 DOI: 10.1542/hpeds.2021-006259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Inpatient asthma education interventions provide benefit compared with usual care, but evaluation of the most effective educational model is needed. We compared the impact of interactive versus didactic inpatient pediatric asthma education on subsequent emergency department (ED) visits and hospitalizations. METHODS Children (aged 2‒16) with asthma admitted to a tertiary care children's hospital with an asthma exacerbation between October 2016 and June 2017 were randomly assigned to interactive or didactic (control) asthma education. The primary outcome was asthma ED visits at 6 and 12 months; secondary outcomes included hospitalizations (6 and 12 months), inhaler technique, asthma knowledge, symptoms, quality of life, and parental management skills at baseline, discharge, and/or 12 months. RESULTS One hundred forty participants (69 interactive, 71 control) completed the study. There were no differences in ED visits at 6 or 12 months. Compared to controls, the interactive group had fewer hospitalizations (10.1% vs 22.5%; P = .04) at 6 months. Inhaler technique in the interactive group improved at discharge (mean change 4.07 [95% confidence interval (CI): 3.21-4.94]) and remained increased at 12 months (P = .03). Patient-reported asthma symptoms and quality of life were similar in both groups at baseline (19.9 vs 20.62, best possible score 8) and significantly improved in the interactive group at 12 months (least square mean change, 3.52 vs -1.75; P < .01). CONCLUSIONS There were no differences in ED visits; however, the interactive education reduced asthma hospitalizations over a 6-month period. These findings demonstrate that educational delivery methods can play a role in improving clinical outcomes for asthma.
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Affiliation(s)
- Waheeda Samady
- Divisions of Hospital-Based Medicine
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Victoria A Rodriguez
- Divisions of Hospital-Based Medicine
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ruchi Gupta
- Academic General Pediatrics
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jacqueline A Pongracic
- Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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14
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Yin HS, Neuspiel DR, Paul IM, Franklin W, Tieder JS, Adirim T, Alvarez F, Brown JM, Bundy DG, Ferguson LE, Gleeson SP, Leu M, Mueller BU, Connor Phillips S, Quinonez RA, Rea C, Rinke ML, Shaikh U, Shiffman RN, Vickers Saarel E, Spencer Cockerham SP, Mack Walsh K, Jones B, Adler AC, Foster JH, Green TP, Houck CS, Laughon MM, Neville K, Reigart JR, Shenoi R, Sullivan JE, Van Den Anker JN, Verhoef PA. Preventing Home Medication Administration Errors. Pediatrics 2021; 148:183379. [PMID: 34851406 DOI: 10.1542/peds.2021-054666] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Medication administration errors that take place in the home are common, especially when liquid preparations are used and complex medication schedules with multiple medications are involved; children with chronic conditions are disproportionately affected. Parents and other caregivers with low health literacy and/or limited English proficiency are at higher risk for making errors in administering medications to children in their care. Recommended strategies to reduce home medication errors relate to provider prescribing practices; health literacy-informed verbal counseling strategies (eg, teachback and showback) and written patient education materials (eg, pictographic information) for patients and/or caregivers across settings (inpatient, outpatient, emergency care, pharmacy); dosing-tool provision for liquid medication measurement; review of medication lists with patients and/or caregivers (medication reconciliation) that includes prescription and over-the-counter medications, as well as vitamins and supplements; leveraging the medical home; engaging adolescents and their adult caregivers; training of providers; safe disposal of medications; regulations related to medication dosing tools, labeling, packaging, and informational materials; use of electronic health records and other technologies; and research to identify novel ways to support safe home medication administration.
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Affiliation(s)
- H Shonna Yin
- Departments of Pediatrics and Population Health, Grossman School of Medicine, New York University, New York, New York
| | | | - Ian M Paul
- Departments of Pediatrics and Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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15
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Curbach J, Lander J, Dierks ML, Grepmeier EM, von Sommoggy J. How do health professionals translate evidence on early childhood allergy prevention into health literacy-responsive practice? A protocol for a mixed-method study on the views of German health professionals. BMJ Open 2021; 11:e047733. [PMID: 34785543 PMCID: PMC8596052 DOI: 10.1136/bmjopen-2020-047733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 10/13/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Paediatricians, general practitioners (GPs) and midwives in primary care are important sources of information for parents on early childhood allergy prevention (ECAP). Research has shown that preventive counselling by health professionals can be effective in improving patients' health literacy (HL) and health behaviour. Providing effective advice relies on two factors. First, health professionals need be up-to-date with research evidence on ECAP, to consider popular misconceptions and fears and to translate this knowledge into clear recommendations for parents (knowledge translation). Second, they need to know and apply counselling techniques and create a practice setting which accommodates parental HL needs (health literacy-responsive care). The objective of this study is to explore and assess how German health professionals take up and translate ECAP evidence into appropriate recommendations for parents, how they consider HL in counselling and practice organisation and what barriers and enablers they find in their performance of HL-responsive ECAP. METHODS AND ANALYSIS The study has a sequential mixed-method design, in two phases. In the first phase, qualitative semi-structured expert interviews will be conducted with health professionals (paediatricians, GPs and midwives) at primary care level and professional policy level. Data collection is ongoing until January 2022. In the second phase, based on the qualitative results, a standardised questionnaire will be developed, and pilot-tested in a wider population of German health professionals. The findings of both phases will be integrated. ETHICS AND DISSEMINATION The study has received ethical approval from the Ethics Committee of the University of Regensburg (18-1205-101). The results will be published in international peer-reviewed open access journals and via presentations at scientific conferences. The results will also be shared with German health professionals, decision-makers and potential funders of interventions.
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Affiliation(s)
- Janina Curbach
- Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany
- Faculty of Businesss Studies, Ostbayerische Technische Hochschule (OTH) Regensburg, Regensburg, Germany
| | - Jonas Lander
- Department of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Marie Luise Dierks
- Department of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Eva-Maria Grepmeier
- Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany
| | - Julia von Sommoggy
- Department of Epidemiology and Preventive Medicine/Medical Sociology, University of Regensburg Faculty of Medicine, Regensburg, Germany
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16
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Ali NM, Combs RM, Kakar RM, Muvuka B, Porter J. Promoting Interdisciplinary, Participatory Approaches to Address Childhood Asthma Disparities in an Urban Black Community. FAMILY & COMMUNITY HEALTH 2021; 44:32-42. [PMID: 33055573 DOI: 10.1097/fch.0000000000000283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Black children are twice as likely as non-Hispanic white children to have asthma due to an interplay of socioeconomic, historical, and industrial factors. The underlying socio-economic and structural inequities result in poor adherence to recommended asthma management treatments. National guidelines suggest asthma action plans (AAPs) as a tool for patient self-management, yet they remain underutilized. Boot Camp Translation (BCT), rooted in community-based participatory research, provides a method for engaging communities to improve health literacy. This article describes the successful use of BCT to develop a culturally relevant AAP promotion campaign in West Louisville, a predominantly Black community that experiences social and health disparities.
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Affiliation(s)
- Nida M Ali
- University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky (Drs Ali, Combs, Kakar, and Muvuka); and Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Dr Porter)
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17
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Merks P, Cameron J, Bilmin K, Świeczkowski D, Chmielewska-Ignatowicz T, Harężlak T, Białoszewska K, Sola KF, Jaguszewski MJ, Vaillancourt R. Medication Adherence and the Role of Pictograms in Medication Counselling of Chronic Patients: a Review. Front Pharmacol 2021; 12:582200. [PMID: 34489688 PMCID: PMC8417421 DOI: 10.3389/fphar.2021.582200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Pharmaceutical care requires a patient-centered approach, focusing on the ability of patients to understand drug-related information and follow the instructions delivered by pharmacists as well as other health-care providers included in the circle of care. With the goal of ensuring the prescribed use of medications, called medication adherence, health-care providers have to consider many risk factors such as geography (culture), social economic status, age, and low literacy that may predispose patients to non-adherence, and considerations have to be made for chronic patients living with life-long disease states. The aim of this review is to provide a balanced and comprehensive review outlining a number of different medication counselling and education approaches that have been used to try to improve medication adherence and health outcomes with the use of clear and concise graphic illustrations—called pictograms. By highlighting the current landscape of the general use and efficacy of pharmaceutical pictograms to aid in the knowledge and recall of drug-related information, as well as outlining specific medication adherence outcomes with pharmaceutical pictograms in chronic patients, the current review describes the need for health-care providers to move beyond the traditional didactic methods of oral and verbal communication with patients regarding medication-taking behavior.
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Affiliation(s)
- Piotr Merks
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland.,Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | - Jameason Cameron
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
| | - Krzysztof Bilmin
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Damian Świeczkowski
- First Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Tomasz Harężlak
- Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | | | | | | | - Regis Vaillancourt
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
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18
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Kakar R, Combs R, Ali N, Muvuka B, Porter J. Enhancing the design and utilization of asthma action plans through community-based participatory research in an urban African American community. PATIENT EDUCATION AND COUNSELING 2021; 104:276-281. [PMID: 32921519 DOI: 10.1016/j.pec.2020.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/17/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Across the U.S., large inequities in asthma prevalence and outcomes persist, disproportionately affecting low-income, minoritized children. West Louisville is particularly impacted by these inequities due to a complex interplay of socioeconomic, historical, and industrial processes. Additionally, low health literacy and mistrust in healthcare exacerbate poor asthma self-management. OBJECTIVE To engage community members and health professionals to address childhood asthma management in a marginalized community experiencing significant health inequities. PATIENT INVOLVEMENT Although prior asthma knowledge was not required, the majority of our community advisory council (CAC) members either had asthma or cared for children/grandchildren with asthma. Through facilitated decision-making using the Boot Camp Translation approach, the CAC chose to focus on improving asthma self-management in their community through enhancing the design and utilization of asthma action plans (AAPs). METHODS Upon adding inhaler images to a user-friendly AAP, the CAC developed and implemented a provider incentive program and a health communication campaign to promote the Tool's utilization. Evaluation of the intervention consisted of a short questionnaire measuring relevant patient demographics and campaign knowledge, and phone interviews with providers to gather feedback on the incentive and Tool design. RESULTS Over the short two-month intervention, a total of 8 practices with 28 providers used 153 Tools to provide asthma self-management counseling. The majority of providers preferred the enhanced Tool to other AAPs they had used. Inhaler images facilitating improved communication regarding asthma medications. DISCUSSION Using a participatory approach, a community preferred intervention targeting barriers to effective asthma control increased provider utilization and community awareness of AAPs and bridged a communication gap between patients and providers. PRACTICAL VALUE Leveraging community members' (including patients/caregivers) and health professionals' expertise led to the development of an enhanced patient-education tool and an effective provider incentive program with the potential to improve childhood asthma management in marginalized populations.
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Affiliation(s)
- Rishtya Kakar
- Department of Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA.
| | - Ryan Combs
- Department of Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA.
| | - Nida Ali
- Department of Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA.
| | - Baraka Muvuka
- Department of Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA.
| | - Jennifer Porter
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.
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19
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Panza C, Volta A, Broccoli S, Bonvicini L, Kendall S, Marchesi M, Giorgi Rossi P. Evaluation of an intervention aimed at supporting new parents: the Baby Newsletter project. Ital J Pediatr 2020; 46:123. [PMID: 32887637 PMCID: PMC7487811 DOI: 10.1186/s13052-020-00886-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Anticipatory guidance for parents is commonly used to improve parenting skills. The objective of this pre/post-intervention controlled study was to evaluate the effectiveness of a periodic newsletter with advice on childcare and development in improving parenting self-efficacy. Methods This was a non-randomized pre/post-intervention controlled study. All the parents of children born between September 2014 and December 2015 resident in the S. Ilario d’Enza municipality (Italy) received eight Baby Newsletters. Parents resident in other municipalities of the same Health District were the control. Parents with linguistic barriers or with preterm or hospitalized children were excluded. Improvement in parenting self-efficacy was measured through the TOPSE (Tool to Measure Parenting Self-Efficacy) questionnaire during the first week (t0) after delivery and at 5 (t1) and 12 months (t2) of life at two vaccination appointments. A score ranging from 0 to 60 was computed for each of the eight domains investigated by the TOPSE. Variations of each TOPSE score between delivery and 12 months in the two groups were compared, adjusting for parity, education, age of parents, and child’s sex, and stratifying by parity and education. Results /findings One hundred thirty-six families accepted to participate in the study. Scores at 12 months were higher than 1 week after delivery in both groups for all TOPSE domains. The improvement was slightly stronger in the Newsletter group for almost all the skills except learning and knowledge [difference in the mean of variation: -0.48 (95% CI: − 3.17; 2.21)]; the difference was significant only for play and enjoyment [2.18 (95% CI: 0.12; 4.25)]. The increase in scores in almost all domains was more pronounced for parents with high education level at first child. Conclusions The intervention was effective in improving parents’ ability to play. However, it risks worsening existing differences between parents with high and with low education levels. Trial registration Clinical trial registration: NCT03268408.
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Affiliation(s)
| | - Alessandro Volta
- Primary Care Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Serena Broccoli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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20
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Abrams EM. The Impact of Caregiver Health Literacy on Pediatric Asthma: An Integrative Review. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2020; 33:110-116. [DOI: 10.1089/ped.2020.1192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Elissa M. Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba Winnipeg, Canada
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21
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Vallabhan MK, Jimenez EY, McCauley GL, Willyard H, Kong AS. Formative Evaluation for Implementation of a Low Literacy Pictorial Asthma Action Plan Delivered via Telehealth Improves Asthma Control. Am J Med Qual 2020; 36:229-237. [PMID: 32830559 DOI: 10.1177/1062860620946838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Consistently uncontrolled asthma in children is an increasing concern in the United States. The use of asthma action plans with asthma education is inconsistent and may be improved with adaptations for low literacy. The objective of this study was formative evaluation for implementation of the New Mexico Pictorial Asthma Action Plan (NM PicAAP). Quality improvement processes guided NM PicAAP face validation and telehealth direct patient care implementation. The asthma control test was selected to measure asthma control. NM PicAAP was revised for face validity, and training curriculum on its use and telehealth implementation processes were developed. Seven youth received NM PicAAP via telehealth direct care, which increased overall asthma control scores over 1 month. NM PicAAP may be useful and effective for improving asthma care in children via telehealth. Additional testing is needed to assess applicability.
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Affiliation(s)
- Monique K Vallabhan
- University of New Mexico, Albuquerque, NM University of New Mexico Health Sciences Center, Albuquerque, NM Nor-Lea Hospital District, Lovington Student Healthcare Center, Lovington, NM
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22
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Zhong Y, Patel N, Ferris M, Rak E. Health literacy, nutrition knowledge, and health care transition readiness in youth with chronic kidney disease or hypertension: A cross-sectional study. J Child Health Care 2020; 24:246-259. [PMID: 30866644 DOI: 10.1177/1367493519831493] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study evaluates the associations of nutrition knowledge and health literacy with health care transition (HCT) readiness and self-management in adolescents and young adults (AYAs) with chronic kidney disease (CKD) or hypertension. Chronically ill AYAs with poor HCT or self-management skills are less likely to achieve favorable health outcomes as they enter adulthood. Health literacy and nutrition knowledge, which are identified as important contributors to health outcomes, may suggest important points of interventions to improve self-management skills. For the study, we enrolled 59 consecutive patients ages 12-29, with a diagnosis of CKD or hypertension at pediatric- and adult-focused clinics in the United States. Participants completed measures of nutrition knowledge, health literacy, and the Self-management and Transition to Adulthood with Rx = treatment (STARx) questionnaire. Correlation tests and multivariate regressions were employed for data analysis. The findings show that health literacy was positively associated with self-management skills (p = .050), communication with providers (p = .002) and overall HCT (p = .001) after adjusting for key variables. Disease-specific nutrition knowledge positively predicted communication with providers (p = .002) and overall HCT (p < .001) after adjusting for key variables. Therefore, health literacy and nutrition knowledge predicted self-management and transition readiness. Testing for these skills should be considered in clinics and HCT preparation for AYAs with chronic conditions.
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Affiliation(s)
- Yi Zhong
- Department of Economics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nikita Patel
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maria Ferris
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eniko Rak
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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23
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Pade KH, Thompson LR, Ravandi B, Chang TP, Barry F, Halterman JS, Szilagyi PG, Okelo SO. Parental perception of a picture-based chronic asthma care management tool in an urban pediatric emergency department. J Asthma 2020; 58:1013-1023. [PMID: 32249659 DOI: 10.1080/02770903.2020.1753210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND National asthma guidelines recommend use of an asthma action plan (AAP) as part of chronic asthma care. Unfortunately, AAPs have not been tailored for use in acute care settings, where many patients at risk for poor chronic asthma care are seen, including those who are non-English-speaking or have low literacy levels. We previously developed a picture-based medication plan (PBMP), a unique type of AAP for use in an ambulatory setting and designed to increase patient use and understanding. However, little is known about how parents seeking emergency department (ED) asthma care would perceive the PBMP. OBJECTIVE To assess parental attitudes toward an asthma PBMP in the largest pediatric ED in Los Angeles County. METHODS We surveyed a consecutive sample of English- or Spanish-speaking parents of children 2-17 years seeking ED asthma care. Parents used a 5-point Likert scale for various statements regarding their perceptions of the PBMP. Responses were analyzed by sociodemographics, asthma control, and health literacy using Chi-squared and t-tests. RESULTS 90 parents provided feedback on the PBMP. The majority of parents endorsed the PBMP. Endorsement was 20%-30% higher among Spanish-speaking parents and those who did not complete high-school compared to English-speaking parents and parents with a high school education or higher (p < 0.05 for both comparisons). CONCLUSION Spanish-speaking parents and parents with less than a high-school education overwhelmingly endorsed the PBMP. It may be useful to consider incorporating the PBMP as part of patient-centered chronic asthma care strategies for populations seen in ED settings.
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Affiliation(s)
- K H Pade
- UCSD School of Medicine, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - L R Thompson
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - B Ravandi
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - T P Chang
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - F Barry
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - J S Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - P G Szilagyi
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - S O Okelo
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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24
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Federico MJ, McFarlane AE, Szefler SJ, Abrams EM. The Impact of Social Determinants of Health on Children with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1808-1814. [PMID: 32294541 DOI: 10.1016/j.jaip.2020.03.028] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 12/20/2022]
Abstract
SzAsthma is the most common chronic disease of childhood. Disparities in asthma outcomes have led to international attention on the biologic, social, economic, and other factors that impact the health of children with asthma. Studies indicate that social determinants of health such as housing, neighborhood safety, and access to care significantly impact the health of children with asthma. However, screening for socioeconomic and environmental factors that impact asthma can be difficult to integrate into clinical practice. In addition, it is not yet clear which interventions to address these factors are most effective. This article will review recent studies of determinants and social determinants of health and propose a framework for identifying and addressing them in the care of children with asthma in a clinical setting.
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Affiliation(s)
- Monica J Federico
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Arthur E McFarlane
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada.
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25
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Poureslami I, Shum J, Kopec J, Sawatzky R, Gupta S, Pakhale S, Kassay S, Starnes K, Akhtar A, FitzGerald JM. Development and Pretesting of a New Functional-Based Health Literacy Measurement Tool for Chronic Obstructive Pulmonary Disease (COPD) and Asthma Management. Int J Chron Obstruct Pulmon Dis 2020; 15:613-625. [PMID: 32256062 PMCID: PMC7094165 DOI: 10.2147/copd.s234418] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Health literacy (HL) is a person’s ability to practically apply a wide range of cognitive and non-cognitive skills in health-related decisions. HL includes five domains: navigate/access, understand, communicate, evaluate, and use of health information and services. Currently, no tool accurately captures and measures HL in adult patients with asthma and COPD, while utilizing all 5-HL domains. Objective Develop a comprehensive functional-based measurement tool for adult asthma and/or COPD patients, while assessing HL on routine actions required to manage their chronic respiratory condition(s). Methods We developed our HL tool based on a conceptualization of the link between HL and asthma and COPD management, during needs assessment stage including; a systematic review, which was followed by patient-oriented focus groups, and key-informant and respirologist interviews. Preliminary face and content validation were obtained by patients’ and health professionals’ input prior to the pretesting stage. The needs assessment information enabled us to develop passages in scenario-format and corresponding items to assess HL core domains, in addition to numeracy skills, across nine self-management topics: peak flow meters, prednisone use, pulmonary rehabilitation, action plans, flu shots, inhaler technique, lifestyle (nutrition and exercise), trigger control, and map navigation. The tool was pretested with asthma and COPD patients to assess its relevance, clarity, and difficulty. Results Our systematic review identified the deficiencies of existing HL tools that assessed the HL skills of asthma and COPD patients. The patient-oriented focus groups (n=93) enabled us to identify self-management topics and develop items for our proposed HL tool, which were enriched by input from 45 key informants (eg, policy makers, clinicians, etc.) and 17 respiratory physicians. Preliminary pretesting with a new cohort of participants (36 asthma and COPD patients and 39 key informants) aided in the refinement and finalized our tool. The modified tool included passages and corresponding items related to asthma and COPD management was pretested with 75 asthma/COPD patients who completed the questionnaire and provided their feedback on the clarity, relevance, and difficulty of the tool. The main barrier to self-management pertained to “communication” skills. The flu shot was the most relevant topic (91.2%), while map navigation was the least relevant (63.9%). Action plans were the most difficult topic, where only 55% knew when to utilize their action plans. Numeracy items challenged COPD patients the most. Conclusion We summarized findings from the development and preliminary testing stages of a new asthma/COPD HL tool. This tool will now be validated with a new cohort of patients. Practice Implications Knowledge gained in this study has been applied to the final version of the tool, which is currently being validated.
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Affiliation(s)
- Iraj Poureslami
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, BC V5Z 1M9, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Jessica Shum
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, BC V5Z 1M9, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Jacek Kopec
- Division of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, BC V2Y 1Y1, Canada
| | - Samir Gupta
- Division of Respirology, Department of Medicine, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | - Smita Pakhale
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Saron Kassay
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, BC V5Z 1M9, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Kassie Starnes
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, BC V5Z 1M9, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Alizeh Akhtar
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine, Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, BC V5Z 1M9, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
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Matson KL, Orr KK, Marino C, Cohen LB. The Effect of a Student Pharmacist Directed Health-Education Program for Elementary-School Children. Innov Pharm 2019; 10. [PMID: 34007596 PMCID: PMC8051904 DOI: 10.24926/iip.v10i4.1457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: The primary objective of this study was to measure the effect of an annual student pharmacist led elementary-school health education program by assessing children’s comprehension of educational sessions. Secondary objectives were to evaluate student pharmacists’ knowledge of health-related topics and practice skills. Methods: Student pharmacists led interactive learning sessions for elementary school students on nutrition, physical activity, summer safety, hygiene, medication safety, and tobacco prevention. Pre- and post-intervention surveys were administered to measure change in knowledge of health promotion and healthy lifestyles. Student pharmacists also completed pre- and post-health education intervention surveys to measure change in self-perception of knowledge, confidence, and practice application of health-related topics and practice skills. Results: Three-hundred and four elementary school children participated in the study with significant knowledge improvements observed in medication safety and tobacco prevention. Twenty-five student pharmacists completed surveys, resulting in a collective self-improvement in each area measured. Conclusion: Interactive educational sessions led by student pharmacists have a positive impact on elementary school children’s knowledge. Student pharmacists also demonstrated professional growth through increased knowledge, confidence, and communication skills in interacting with pediatric populations. Practice Implication: A co-curricular educational activity allowed student pharmacists to promote health and wellness to elementary students, a Healthy People 2020 goal, while also providing an opportunity to develop professional skills for future practice with pediatric patients.
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Affiliation(s)
- Kelly L Matson
- Department of Pharmacy Practice, College of Pharmacy, The University of Rhode Island
| | - Katherine K Orr
- Department of Pharmacy Practice, College of Pharmacy, The University of Rhode Island
| | - Caitlin Marino
- Department of Pharmacy, University of Rochester Medical Center
| | - Lisa B Cohen
- Department of Pharmacy Practice, College of Pharmacy, The University of Rhode Island
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Arcia A, George M, Lor M, Mangal S, Bruzzese JM. Design and Comprehension Testing of Tailored Asthma Control Infographics for Adults with Persistent Asthma. Appl Clin Inform 2019; 10:643-654. [PMID: 31486056 PMCID: PMC6727064 DOI: 10.1055/s-0039-1693713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/17/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Adherence to daily inhaled corticosteroid medication is important for asthma control but low health literacy is a barrier to comprehension of control status and may contribute to medication nonadherence. Infographics tailored with patients' own data can support comprehension of health status, but these have not been applied to asthma successfully. OBJECTIVES This two-phased study developed and tested tailored infographics of (1) scores on the Asthma Control Questionnaire (ACQ), a self-report measure of symptom burden, and (2) pulmonary function test (PFT) results. The infographics are intended for use as communication and adherence-promotion tools in clinical interactions. METHODS For both phases, participants (18+ years, English- or Spanish-speaking, persistent asthma) were recruited through two primary care clinics. In Phase I, we used a hybrid iterative participatory design process to refine prototype designs. In Phase II, we conducted individual comprehension assessment interviews with the finalized designs. Infographics were hand-tailored for each participant using their ACQ score and PFT results collected at the start of the interview. Two independent raters scored interview transcripts for gist and verbatim comprehension based on a predetermined rubric. RESULTS The five Phase I design sessions led to final prototypes that participants (n = 21) considered appealing and easy to comprehend. All Phase II participants (n = 10) demonstrated complete gist and verbatim comprehension. Participants reacted favorably to receiving their information via infographics and expressed intentions to engage in self-management behaviors (e.g., medication adherence, smoking cessation, weight loss, and review of their care plan) in response to the information. CONCLUSION This study provides preliminary evidence that infographics can support comprehension of asthma control status and promote self-management intentions among adults with persistent asthma. Infographics can be programmed into electronic health records and/or standalone applications to allow for instant tailoring at the point of care.
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Affiliation(s)
- Adriana Arcia
- Columbia University School of Nursing, New York, New York, United States
| | - Maureen George
- Columbia University School of Nursing, New York, New York, United States
| | - Maichou Lor
- Columbia University School of Nursing, New York, New York, United States
| | - Sabrina Mangal
- Columbia University School of Nursing, New York, New York, United States
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Platter E, Hamline MY, Tancredi DJ, Fernandez Y Garcia E, Rosenthal JL. Completeness of Written Discharge Guidance for English- and Spanish-Speaking Patient Families. Hosp Pediatr 2019; 9:516-522. [PMID: 31182648 DOI: 10.1542/hpeds.2018-0250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Written discharge guidance for hospitalized pediatric patients should include language-appropriate key elements to ensure positive discharge outcomes. Our objective in this study was to determine the completeness of written pediatric discharge guidance and to test the hypothesis that Spanish-speaking families with limited English proficiency (LEP) receive less complete written discharge guidance than English-speaking families. METHODS We conducted a retrospective review of written discharge guidance provided to 100 English- and 100 Spanish-speaking families at an urban nonfreestanding children's hospital to assess the inclusion of key elements: follow-up plan, contingency plan, telephone contact, discharge medications, discharge diagnosis, and hospital course. We compared the completeness of discharge guidance (number of elements provided among number of applicable elements) between English- versus Spanish-speaking families. RESULTS When evaluating discharge guidance for the presence of key elements in any language, there was no significant difference between English- and Spanish-speaking families. However, the mean completeness of language-appropriate discharge guidance for English- and Spanish-speaking families was 87.8% (95% confidence interval [CI] 84.4%-91.1%) and 16.0% (95% CI 11.5%-20.4%), respectively. The ordinal logistic regression examining the association between the number of key element deficits and English- (reference group) versus Spanish-speaking families demonstrated an adjusted odds ratio of 339.8 (95% CI 112.4-1027.5). CONCLUSIONS Few Spanish-speaking families with LEP receive written discharge guidance in their preferred language. Complete, language-appropriate discharge guidance was identified as an area for improvement efforts to work toward improving care provided to families with LEP.
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Affiliation(s)
- Erin Platter
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia; and
| | - Michelle Y Hamline
- Department of Pediatrics, University of California, Davis, Sacramento, California
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis, Sacramento, California
| | | | - Jennifer L Rosenthal
- Department of Pediatrics, University of California, Davis, Sacramento, California
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Abstract
Health literacy is an important issue to consider in the provision of health-care to children. Similar to the adult population, most parents face health literacy challenges. Of particular concern, 1 in 4 parents have low health literacy, greatly affecting their ability to use health information to make health decisions for their child. High expectations are placed on parents and children to achieve effective disease management and positive health outcomes in the context of complex health-care systems and disease treatment regimens. Low health literacy affects parent acquisition of knowledge, attitudes, and behaviors, as well as child health outcomes across the domains of disease prevention, acute illness care, and chronic illness care. The effect of low health literacy is wide ranging, including 1) poor nutrition knowledge and behaviors, 2) higher obesity rates, 3) more medication errors, 4) more emergency department use, and 5) poor asthma knowledge, behaviors, and outcomes. Health-care providers can mitigate the effects of health literacy by seeking to align health-care demands with the health literacy skills of families. Effective health literacy-informed interventions provide insights into methods that can be used by providers and health systems to improve health outcomes. Health literacy-informed communication strategies should be used with all families in a "universal precautions approach" because all parents likely benefit from clear communication. As scientific advances are made in disease prevention and management, unless families understand how to follow provider recommendations, the benefit of these advances will not be realized and disparities in outcomes will be exacerbated.
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Affiliation(s)
- Andrea K Morrison
- Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - H Shonna Yin
- Department of Pediatrics and.,Department of Population Health, New York University School of Medicine/NYU Langone Health, New York, NY
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Sleep Problem Detection and Documentation in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder by Developmental-Behavioral Pediatricians: A DBPNet Study. J Dev Behav Pediatr 2019; 40:20-31. [PMID: 30589766 DOI: 10.1097/dbp.0000000000000624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the percentage of children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and combined ASD + ADHD who had sleep problems documented by developmental-behavioral pediatricians at diagnostic and follow-up visits at 12 US academic medical centers comprising the Developmental-Behavioral Pediatrics Research Network (DBPNet) and to identify the predictors of sleep problem documentation. METHODS Developmental-behavioral pediatricians completed encounter forms that covered sociodemographic, medical, clinician, and visit factors. There was 1 dependent variable, sleep problem documentation, for which 4 definitions were developed (Model 1 = Sleep Disorder coded; Model 2 = Sleep Disorder or polysomnogram coded; Model 3 = Sleep Disorder, polysomnogram, or sleep medication coded; and Model 4 = Sleep Disorder, polysomnogram, sleep medication, or clonidine coded). RESULTS Sleep problem documentation was 14.1% for Model 1, 15.2% for Model 2, 17.3% for Model 3, and 19.7% for Model 4. All values were lower (p < 0.001) than the reported prevalence of sleep problems in these conditions. For Model 4, predictors of sleep problem documentation were age group, ethnicity, medical insurance type, and DBPNet site. CONCLUSION Developmental-behavioral pediatricians in DBPNet under-reported sleep problems in children with ASD and ADHD. Variation among sites was substantial. Care plans for children with ASD and ADHD should specify which treating clinician(s) monitors sleep issues.
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Poureslami I, Shum J, Lester RT, Tavakoli H, Dorscheid DR, FitzGerald JM. A pilot randomized controlled trial on the impact of text messaging check-ins and a web-based asthma action plan versus a written action plan on asthma exacerbations. J Asthma 2018; 56:1-13. [PMID: 30003851 DOI: 10.1080/02770903.2018.1500583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/16/2018] [Accepted: 07/09/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE We compared electronic asthma action plans (eAAP) supported by automated text messaging service (SMS) with written asthma action plans (AAP) on assessing acceptability and asthma control improvement. We hypothesized that the patients in eAAP group would have more improvements in their quality of life, asthma control and decreased asthma exacerbations. METHODS Patients with physician-diagnosed asthma having at least one asthma exacerbation in the previous 12 months were recruited. Participants received individualized action plans and were randomly assigned into either the intervention (eAAP) or control (AAP) group. Intervention participants received weekly SMS, triggering assessment of asthma control and viewing their eAAP. We assessed applicability of Telehealth platform on asthma exacerbations, asthma control, and quality of life over a 12-month period. RESULTS 106 patients were enrolled (eAAP = 52, AAP = 54). The cumulative response rate to all weekly SMS check-ins was 68.4%. Overall, 28% of patients checked into their eAAP during the intervention period. There were fewer exacerbations in the eAAP group (18%) compared to the AAP group (RR = 0.82 [95%CI 0.49, 1.36]), (P = 0.44). The mean scores for asthma control and quality of life were higher in the eAAP group compared to the AAP group by 4% (RR = 1.04 [95%CI 0.83, 1.30]), (P = 0.73) and 5.5% (RR = 1.06 [95%CI 0.87, 1.28]), (P = 0.59), respectively, but were not statistically significant. CONCLUSIONS We demonstrated that the eAAP presented improved asthma control outcomes, but as expected the sample size was inadequate to show a significant difference, but based on this pilot study we plan a larger appropriately powered randomized controlled trial (RCT).
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Affiliation(s)
- Iraj Poureslami
- a Division of Respiratory Medicine, Department of Medicine , Institute for Heart and Lung Health, The University of British Columbia , Vancouver , Canada
- b Centre for Clinical Epidemiology and Evaluation , Vancouver Coastal Health Research Institute, The University of British Columbia , Vancouver , Canada
| | - Jessica Shum
- a Division of Respiratory Medicine, Department of Medicine , Institute for Heart and Lung Health, The University of British Columbia , Vancouver , Canada
- b Centre for Clinical Epidemiology and Evaluation , Vancouver Coastal Health Research Institute, The University of British Columbia , Vancouver , Canada
| | - Richard T Lester
- c Division of Infectious Diseases, Department of Medicine , The University of British Columbia , Vancouver , Canada
| | - Hamid Tavakoli
- d Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences , The University of British Columbia , Vancouver , Canada
| | - Delbert R Dorscheid
- e Centre for Heart Lung Innovation, St. Paul's Hospital , The University of British Columbia , Vancouver , Canada
| | - J Mark FitzGerald
- a Division of Respiratory Medicine, Department of Medicine , Institute for Heart and Lung Health, The University of British Columbia , Vancouver , Canada
- b Centre for Clinical Epidemiology and Evaluation , Vancouver Coastal Health Research Institute, The University of British Columbia , Vancouver , Canada
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Egan M, Yin HS, Greenhawt M, Wang J. Low caregiver health literacy among pediatric food-allergic patients is associated with poorer food allergy management knowledge. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:655-658. [PMID: 30007848 DOI: 10.1016/j.jaip.2018.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Maureen Egan
- Section of Pediatric Allergy and Immunology, Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colo.
| | - H Shonna Yin
- Departments of Pediatrics and Population Health, New York University School of Medicine, New York, NY
| | - Matthew Greenhawt
- Section of Pediatric Allergy and Immunology, Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colo
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY
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Stukus DR, Farooqui N, Strothman K, Ryan K, Zhao S, Stevens JH, Cohen DM. Real-world evaluation of a mobile health application in children with asthma. Ann Allergy Asthma Immunol 2018; 120:395-400.e1. [PMID: 29452259 DOI: 10.1016/j.anai.2018.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/25/2018] [Accepted: 02/02/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Mobile health applications for asthma are increasingly being developed. However, there are no published randomized controlled trials evaluating efficacy in decreasing exacerbations. OBJECTIVE To evaluate the impact of a mobile asthma application for asthma-related urgent health care usage. METHODS We conducted a 6-month prospective randomized controlled trial for patients (6 months-21 years old) with persistent asthma presenting with an asthma exacerbation to the emergency department of a pediatric academic medical center. Participants were randomized to AsthmaCare (application providing medication and trigger reminders and treatment plan) or the control (online asthma information). Primary outcome measures were comparison of emergency department and urgent care visits and hospitalizations 6 months before and after randomization. RESULTS AsthmaCare participants (n = 98) were slightly older (7.84 vs 6.24 years; P = .02) than controls (n = 95) but similar for sex (55% vs 62% boys), race (83% vs 77% African American), and insurer (89% vs 98% Medicaid). The 2 groups were similar in having more than 2 comorbidities (34% vs 32%) and receiving National Heart, Lung, and Blood Institute step 3 treatment or higher (69% vs 57%). There was no significant decrease in emergency department or urgent care visits or hospitalizations between the intervention and control groups. AsthmaCare participants were more likely to report improvement in asthma management 6 months after study enrollment (79% vs 64%; P = .06). CONCLUSION This randomized controlled trial did not demonstrate a significant decrease in asthma-related emergency department visits or hospitalizations among children who used a mobile health application. TRIAL REGISTRATION ClinicalTrials.gov, Identifier NCT02333630.
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Affiliation(s)
- David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio.
| | | | - Kasey Strothman
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kelsey Ryan
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Songzhu Zhao
- Center for Biostatistics at The Ohio State University, Nationwide Children's Hospital, Columbus, Ohio
| | - Jack H Stevens
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio
| | - Daniel M Cohen
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
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Colorafi K, Moua L, Shaw M, Ricker D, Postma J. Assessing the value of the Meaningful Use Clinical Summary for patients and families with pediatric asthma. J Asthma 2018; 55:1068-1076. [PMID: 29106306 DOI: 10.1080/02770903.2017.1391283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Electronic clinical summaries are innovations supported by the Electronic Health Record Incentive Program, known as "Meaningful Use" (MU). The MU clinical summary documents the shared understanding of the plan of care for patients and assists families in managing asthma-related health care. The purpose of this analysis was to identify the communicative value of the summaries to patients and families. Readability measurements, content analysis, and descriptive statistics were employed in a review of twenty clinical summaries and compared with provider encounter notes. The average age of the patients from whom we collected clinical summaries was six years old. The average reading level of the summaries was ninth grade. Neither summaries nor health education contained visual images. There was a total of nine different asthma diagnoses. A full list of diagnoses was present in 45% of summaries. The average medications per patient was 5.75, and there were multiple medication changes noted (dosage adjustment, add, discontinued). Allergies, vital signs, and smoking status were reliably reported (99-100%). Provider orders present included medication, follow up, and return to the clinic instructions. The plan of care was replicated on 45% of summaries. There was variable reporting of various asthma guidelines. Opportunities to improve the clinical summary include using plain language to promote readability, action, understanding, and health literacy, training providers to standardize their documentation and include asthma action plans, and configuring EHR settings to ensure diagnoses and plan of care is carried over from provider notes to the summary.
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Affiliation(s)
- Karen Colorafi
- a Washington State University , College of Nursing , Spokane , United States
| | - Lee Moua
- a Washington State University , College of Nursing , Spokane , United States
| | - Michele Shaw
- a Washington State University , College of Nursing , Spokane , United States
| | - David Ricker
- b Mary Bridge Children's Hospital and Health Center , Pediatrics , Tacoma , United States
| | - Julie Postma
- c University of Washington, Family and Child Nursing , Seattle , United States
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Developing a written action plan for children with eczema: a qualitative study. Br J Gen Pract 2017; 68:e81-e89. [PMID: 29203680 PMCID: PMC5774967 DOI: 10.3399/bjgp17x693617] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/21/2017] [Indexed: 12/23/2022] Open
Abstract
Background Eczema is common in children but adherence to treatments is poor. Written action plans (WAPs) have been shown to help in asthma but the potential value, format, and content of an eczema WAP is unknown. Aim To explore the potential role of an eczema WAP, and to design an eczema-specific WAP. Design and setting A qualitative study of parents of children with eczema, primary and secondary care health professionals, and other stakeholders. Method A total of 41 semi-structured one-to-one interviews and two focus groups were audiorecorded, transcribed, and analysed thematically. Results Reported challenges of managing eczema included: parental confusion about treatment application; lack of verbal and written advice from GPs; differing beliefs about the cause and management of eczema; re-prescribing of failed treatments; and parents feeling unsupported by their GP. An eczema WAP was viewed as an educational tool that could help address these problems. Participants expressed a preference for a WAP that gives clear, individualised guidance on treatment use, presented in a step-up/step-down approach. Participants also wanted more general information about eczema, its potential triggers, and how to manage problem symptoms. Conclusion An eczema WAP may help overcome some of the difficulties of managing eczema, and support families and clinicians in the management of the condition. Further evaluation is needed to determine if the eczema WAP the authors have developed is both acceptable and improves the outcomes for affected children and their families.
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Gillette C, Rockich-Winston N, Shepherd M, Flesher S. Children with asthma and their caregivers help improve written asthma action plans: A pilot mixed-method study. J Asthma 2017; 55:609-614. [PMID: 28759273 DOI: 10.1080/02770903.2017.1355379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objectives of this study were to (a) qualitatively examine caregiver and child feedback about a gold standard written asthma action plan (WAAP), and (b) determine whether having an asthma action plan was associated with child and caregiver self-efficacy in managing an exacerbation. METHODS This was a cross-sectional analysis of structured interviews with 22 children with persistent asthma that collected feedback about the WAAP as well as self-efficacy. An analysis of interviews used the constant comparative method to identify themes of child and caregiver statements. Caregivers completed a questionnaire that measured asthma management self-efficacy, barriers to managing asthma, and belief in the treatment efficacy using validated scales. RESULTS Approximately 36% of the caregivers reported having a WAAP for their child from their child's pediatrician. Most caregivers stated that having pictures would improve the WAAP, while most children stated that the layout needed to be improved by adding more space between the sections. Caregivers who reported knowing what the asthma action plan was had greater self-efficacy than caregivers who did not (z = -1.99, p = 0.047). CONCLUSIONS Re-designing the current WAAP layout and including pictures of inhalers may promote patient understanding. Future research needs to examine if a re-designed WAAP improves asthma management of children with asthma and their caregivers.
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Affiliation(s)
- Chris Gillette
- a School of Pharmacy , Wingate University , Wingate , NC , USA
| | - Nicole Rockich-Winston
- a School of Pharmacy , Wingate University , Wingate , NC , USA.,c School of Pharmacy , Marshall University , Huntington , WV , USA
| | - Meagan Shepherd
- b Joan C. Edwards School of Medicine , Marshall University , Huntington , WV , USA
| | - Susan Flesher
- b Joan C. Edwards School of Medicine , Marshall University , Huntington , WV , USA
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Glick AF, Farkas JS, Nicholson J, Dreyer BP, Fears M, Bandera C, Stolper T, Gerber N, Yin HS. Parental Management of Discharge Instructions: A Systematic Review. Pediatrics 2017; 140:e20164165. [PMID: 28739657 PMCID: PMC5527669 DOI: 10.1542/peds.2016-4165] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 12/24/2022] Open
Abstract
CONTEXT Parents often manage complex instructions when their children are discharged from the inpatient setting or emergency department (ED); misunderstanding instructions can put children at risk for adverse outcomes. Parents' ability to manage discharge instructions has not been examined before in a systematic review. OBJECTIVE To perform a systematic review of the literature related to parental management (knowledge and execution) of inpatient and ED discharge instructions. DATA SOURCES We consulted PubMed/Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane CENTRAL (from database inception to January 1, 2017). STUDY SELECTION We selected experimental or observational studies in the inpatient or ED settings in which parental knowledge or execution of discharge instructions were evaluated. DATA EXTRACTION Two authors independently screened potential studies for inclusion and extracted data from eligible articles by using a structured form. RESULTS Sixty-four studies met inclusion criteria; most (n = 48) were ED studies. Medication dosing and adherence errors were common; knowledge of medication side effects was understudied (n = 1). Parents frequently missed follow-up appointments and misunderstood return precaution instructions. Few researchers conducted studies that assessed management of instructions related to diagnosis (n = 3), restrictions (n = 2), or equipment (n = 1). Complex discharge plans (eg, multiple medicines or appointments), limited English proficiency, and public or no insurance were associated with errors. Few researchers conducted studies that evaluated the role of parent health literacy (ED, n = 5; inpatient, n = 0). LIMITATIONS The studies were primarily observational in nature. CONCLUSIONS Parents frequently make errors related to knowledge and execution of inpatient and ED discharge instructions. Researchers in the future should assess parental management of instructions for domains that are less well studied and focus on the design of interventions to improve discharge plan management.
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Affiliation(s)
- Alexander F Glick
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Jonathan S Farkas
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | | | - Benard P Dreyer
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Melissa Fears
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Christopher Bandera
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Tanya Stolper
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Nicole Gerber
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - H Shonna Yin
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
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Chauhan BF, Jeyaraman MM, Singh Mann A, Lys J, Abou‐Setta AM, Zarychanski R, Ducharme FM. Addition of anti-leukotriene agents to inhaled corticosteroids for adults and adolescents with persistent asthma. Cochrane Database Syst Rev 2017; 3:CD010347. [PMID: 28301050 PMCID: PMC6464690 DOI: 10.1002/14651858.cd010347.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Asthma management guidelines recommend low-dose inhaled corticosteroids (ICS) as first-line therapy for adults and adolescents with persistent asthma. The addition of anti-leukotriene agents to ICS offers a therapeutic option in cases of suboptimal control with daily ICS. OBJECTIVES To assess the efficacy and safety of anti-leukotriene agents added to ICS compared with the same dose, an increased dose or a tapering dose of ICS (in both arms) for adults and adolescents 12 years of age and older with persistent asthma. Also, to determine whether any characteristics of participants or treatments might affect the magnitude of response. SEARCH METHODS We identified relevant studies from the Cochrane Airways Group Specialised Register of Trials, which is derived from systematic searches of bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, the Allied and Complementary Medicine Database (AMED), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the trial registries clinicaltrials.gov and ICTRP from inception to August 2016. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) of adults and adolescents 12 years of age and older on a maintenance dose of ICS for whom investigators added anti-leukotrienes to the ICS and compared treatment with the same dose, an increased dose or a tapering dose of ICS for at least four weeks. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. The primary outcome was the number of participants with exacerbations requiring oral corticosteroids (except when both groups tapered the dose of ICS, in which case the primary outcome was the % reduction in ICS dose from baseline with maintained asthma control). Secondary outcomes included markers of exacerbation, lung function, asthma control, quality of life, withdrawals and adverse events. MAIN RESULTS We included in the review 37 studies representing 6128 adult and adolescent participants (most with mild to moderate asthma). Investigators in these studies used three leukotriene receptor antagonists (LTRAs): montelukast (n = 24), zafirlukast (n = 11) and pranlukast (n = 2); studies lasted from four weeks to five years. Anti-leukotrienes and ICS versus same dose of ICSOf 16 eligible studies, 10 studies, representing 2364 adults and adolescents, contributed data. Anti-leukotriene agents given as adjunct therapy to ICS reduced by half the number of participants with exacerbations requiring oral corticosteroids (risk ratio (RR) 0.50, 95% confidence interval (CI) 0.29 to 0.86; 815 participants; four studies; moderate quality); this is equivalent to a number needed to treat for additional beneficial outcome (NNTB) over six to 16 weeks of 22 (95% CI 16 to 75). Only one trial including 368 participants reported mortality and serious adverse events, but events were too infrequent for researchers to draw a conclusion. Four trials reported all adverse events, and the pooled result suggested little difference between groups (RR 1.06, 95% CI 0.92 to 1.22; 1024 participants; three studies; moderate quality). Investigators noted between-group differences favouring the addition of anti-leukotrienes for morning peak expiratory flow rate (PEFR), forced expiratory volume in one second (FEV1), asthma symptoms and night-time awakenings, but not for reduction in β2-agonist use or evening PEFR. Anti-leukotrienes and ICS versus higher dose of ICSOf 15 eligible studies, eight studies, representing 2008 adults and adolescents, contributed data. Results showed no statistically significant difference in the number of participants with exacerbations requiring oral corticosteroids (RR 0.90, 95% CI 0.58 to 1.39; 1779 participants; four studies; moderate quality) nor in all adverse events between groups (RR 0.96, 95% CI 0.89 to 1.03; 1899 participants; six studies; low quality). Three trials reported no deaths among 834 participants. Results showed no statistically significant differences in lung function tests including morning PEFR and FEV1 nor in asthma control measures including use of rescue β2-agonists or asthma symptom scores. Anti-leukotrienes and ICS versus tapering dose of ICSSeven studies, representing 1150 adults and adolescents, evaluated the combination of anti-leukotrienes and tapering-dose of ICS compared with tapering-dose of ICS alone and contributed data. Investigators observed no statistically significant difference in % change from baseline ICS dose (mean difference (MD) -3.05, 95% CI -8.13 to 2.03; 930 participants; four studies; moderate quality), number of participants with exacerbations requiring oral corticosteroids (RR 0.46, 95% CI 0.20 to 1.04; 542 participants; five studies; low quality) or all adverse events (RR 0.95, 95% CI 0.83 to 1.08; 1100 participants; six studies; moderate quality). Serious adverse events occurred more frequently among those taking anti-leukotrienes plus tapering ICS than in those taking tapering doses of ICS alone (RR 2.44, 95% CI 1.52 to 3.92; 621 participants; two studies; moderate quality), but deaths were too infrequent for researchers to draw any conclusions about mortality. Data showed no improvement in lung function nor in asthma control measures. AUTHORS' CONCLUSIONS For adolescents and adults with persistent asthma, with suboptimal asthma control with daily use of ICS, the addition of anti-leukotrienes is beneficial for reducing moderate and severe asthma exacerbations and for improving lung function and asthma control compared with the same dose of ICS. We cannot be certain that the addition of anti-leukotrienes is superior, inferior or equivalent to a higher dose of ICS. Scarce available evidence does not support anti-leukotrienes as an ICS sparing agent, and use of LTRAs was not associated with increased risk of withdrawals or adverse effects, with the exception of an increase in serious adverse events when the ICS dose was tapered. Information was insufficient for assessment of mortality.
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Affiliation(s)
- Bhupendrasinh F Chauhan
- Children’s Hospital Research Institute of ManitobaBiology of Breathing GroupWinnipegCanada
- University of ManitobaCollege of PharmacyWinnipegMBCanada
- University of ManitobaKnowledge Synthesis Platform, George and Fay Yee Centre for Healthcare InnovationWinnipegCanada
- University of MontrealDepartment of PaediatricsMontrealCanada
| | - Maya M Jeyaraman
- University of ManitobaKnowledge Synthesis Platform, George and Fay Yee Centre for Healthcare InnovationWinnipegCanada
| | - Amrinder Singh Mann
- University of ManitobaKnowledge Synthesis Platform, George and Fay Yee Centre for Healthcare InnovationWinnipegCanada
| | - Justin Lys
- University of ManitobaKnowledge Synthesis Platform, George and Fay Yee Centre for Healthcare InnovationWinnipegCanada
| | - Ahmed M Abou‐Setta
- University of ManitobaKnowledge Synthesis Platform, George and Fay Yee Centre for Healthcare InnovationWinnipegCanada
| | - Ryan Zarychanski
- University of ManitobaKnowledge Synthesis Platform, George and Fay Yee Centre for Healthcare InnovationWinnipegCanada
- University of ManitobaCommunity Health SciencesWinnipegMBCanadaR3A 1R9
- CancerCare ManitobaDepartment of Haematology and Medical OncologyWinnipegCanadaR3E 0V9
- University of ManitobaDepartment of Internal MedicineWinnipegCanada
| | - Francine M Ducharme
- University of MontrealDepartment of PaediatricsMontrealCanada
- CHU Sainte‐JustineResearch CentreMontrealCanada
- University of MontrealDepartment of Social and Preventive MedicineMontrealCanada
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39
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Borges K, Sibbald C, Hussain-Shamsy N, Vasilevska-Ristovska J, Banh T, Patel V, Brooke J, Piekut M, Reddon M, Aitken-Menezes K, McNaughton A, Pearl RJ, Langlois V, Radhakrishnan S, Licht CPB, Piscione TD, Levin L, Noone D, Hebert D, Parekh RS. Parental Health Literacy and Outcomes of Childhood Nephrotic Syndrome. Pediatrics 2017; 139:peds.2016-1961. [PMID: 28213606 DOI: 10.1542/peds.2016-1961] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Determine the association of parental health literacy with treatment response among children with nephrotic syndrome. METHODS This was a cohort study of children aged 1-18 with nephrotic syndrome and their parent. Health literacy was measured using the validated Short Test of Functional Health Literacy in Adults assessing reading comprehension and numeracy. Outcomes included initial relapse-free period, frequently relapsing disease, relapse rate, second-line medication use, and complete remission after therapy. RESULTS Of 190 parents, 80% had adequate health literacy (score >67 of 100), and higher scores were not correlated with higher education. Almost all achieved perfect numeracy scores (>86%); numeracy was not associated with outcomes. After adjusting for immigration, education, and income, higher reading comprehension scores (tertile 3) compared with lower scores (tertile 1) were significantly associated with lower risk of first relapse (hazard ratio 0.67, 95% confidence interval [CI] 0.48-0.94, P trend = .02), lower odds of frequently relapsing disease (odds ratio [OR] 0.38, 95% CI 0.21-0.70, P trend = .002), lower relapse rate (rate ratio 0.77, 95% CI 0.73-0.80, P trend < .001), and higher odds of complete remission after both initial steroids and cyclophosphamide (OR 2.07, 95% CI 1.36-3.16, P trend = .003; OR 5.97, 95% CI 2.42-14.7, P trend < .001). CONCLUSIONS Lower parental health literacy, specifically reading comprehension, is associated with higher relapse rates among children with nephrotic syndrome and fewer achieving complete remission. This underscores the importance of assessing and targeting health literacy for chronic management of childhood-onset diseases.
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Affiliation(s)
| | - Cathryn Sibbald
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Tonny Banh
- Child Health Evaluative Sciences, Research Institute
| | - Viral Patel
- Child Health Evaluative Sciences, Research Institute
| | | | | | | | | | | | - Rachel J Pearl
- Child Health Evaluative Sciences, Research Institute.,Division of Nephrology, and.,Brampton Civic Hospital, William Osler Health System, Brampton, Canada
| | - Valerie Langlois
- Child Health Evaluative Sciences, Research Institute.,Division of Nephrology, and
| | | | - Christoph P B Licht
- Child Health Evaluative Sciences, Research Institute.,Division of Nephrology, and.,Program in Cell Biology, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Tino D Piscione
- Child Health Evaluative Sciences, Research Institute.,Division of Nephrology, and
| | - Leo Levin
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Damien Noone
- Child Health Evaluative Sciences, Research Institute.,Division of Nephrology, and
| | - Diane Hebert
- Child Health Evaluative Sciences, Research Institute.,Division of Nephrology, and
| | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, .,Department of Medicine, University of Toronto, Toronto, Canada.,Division of Nephrology, and.,University Health Network, Toronto, Canada; and.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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40
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Riera A, Ocasio A, Tiyyagura G, Thomas A, Goncalves P, Krumeich L, Ragins K, Trevino S, Vaca FE. A web-based educational video to improve asthma knowledge for limited English proficiency Latino caregivers. J Asthma 2016; 54:624-631. [PMID: 27780380 DOI: 10.1080/02770903.2016.1251597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate limited English proficiency (LEP) Latino caregiver asthma knowledge after exposure to an educational video designed for this target group. METHODS A cross-sectional, interventional study was performed. We aimed to evaluate the post-test impact on asthma knowledge from baseline after exposure to a patient-centered, evidence-based, and professionally produced Spanish asthma educational video. Participants included LEP Latino caregivers of children 2-12 years old with persistent asthma. Enrollment was performed during ED encounters or scheduled through a local community organization. Asthma knowledge was measured with a validated Spanish parental asthma knowledge questionnaire. Differences in mean scores were calculated with a paired t-test. RESULTS Twenty caregivers were enrolled. Participants included mothers (100%) from Puerto Rico (75%), with a high-school diploma or higher (85%), with no written asthma action plan (65%), whose child's asthma diagnosis was present for at least 3 years (80%). Mean baseline asthma knowledge scores improved 8 points from 58.4 to 66.4 after watching the educational video (95% CI 5.3-10.7; t(19) = 6.21, p < 0.01). Knowledge improvements were similar across the ED and community groups. Knowledge gains were observed in the areas of ED utilization, medication usage, and activity limitations. CONCLUSIONS The developed educational video improved caregiver asthma knowledge for a Latino population facing communication barriers to quality asthma care. Dissemination of this educational resource to LEP caregivers has the potential to improve pediatric asthma care in the United States.
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Affiliation(s)
- Antonio Riera
- a Yale University School of Medicine, Pediatric Emergency Medicine , New Haven , CT , USA
| | - Agueda Ocasio
- b Junta for Progressive Action , New Haven , CT , USA
| | - Gunjan Tiyyagura
- a Yale University School of Medicine, Pediatric Emergency Medicine , New Haven , CT , USA
| | - Anita Thomas
- c University of Washington School of Medicine, Pediatric Emergency Medicine , Seattle , WA , USA
| | - Patricia Goncalves
- d Yale-New Haven Children's Hospital, Pediatric Respiratory Medicine , New Haven , CT , USA
| | | | - Kyle Ragins
- f University of California Los Angeles, Emergency Medicine , Los Angeles , CA , USA
| | | | - Federico E Vaca
- b Junta for Progressive Action , New Haven , CT , USA.,g Yale University School of Medicine, Emergency Medicine , New Haven , CT , USA
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