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Spray J, Hunleth J. Breathing Together: Children Co-constructing Asthma Self-Management in the United States. Cult Med Psychiatry 2022; 47:301-328. [PMID: 35132504 PMCID: PMC8821853 DOI: 10.1007/s11013-022-09766-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 11/30/2022]
Abstract
Pediatric asthma management in the U.S. is primarily oriented around caregivers. As evident in policy, clinical literature and provider practices, this caregiver-centric approach assumes unidirectional transfer of practices and knowledge within particular relational configurations of physicians, caregivers, and children. Reflecting broader societal values and hierarchies, children are positioned as passive recipients of care, as apprentices for future citizenship, and as the responsibility of parents who will train them in the knowledge and labor of asthma management. These ideas, though sometimes contradictory, contribute to a systemic marginalization of children as participants in their health care, leaving a conceptual gap regarding children's inclusion in chronic illness management: what children's roles in their health care are or should be. We address this conceptual gap by asking, what does pediatric asthma management look like when we center children, rather than caregivers in our lens? We draw data from a study of asthma management in St. Louis, Missouri, and Gainesville, Florida, which included 41 caregivers, 24 children, and 12 health-care providers. By asking children to show us how they manage asthma, we find that children actively co-construct health practices within broader interdependencies of care and the structural constraints of childhoods.
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Affiliation(s)
- Julie Spray
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA.
- School of Population Health, Section of Social and Community Health, University of Auckland, Auckland, New Zealand.
| | - Jean Hunleth
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Volerman A, Fierstein J, Boon K, Vojta D, Gupta R. Determinants of asthma knowledge and practices among caregivers of children with moderate-to-severe persistent asthma. Ann Allergy Asthma Immunol 2021; 127:392-394. [PMID: 34098112 DOI: 10.1016/j.anai.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/18/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago Medicine, Chicago, Illinois
| | - Jamie Fierstein
- Department of Pediatrics, Northwestern University, Evanston, Illinois
| | - Kathy Boon
- Department of Pediatrics, Northwestern University, Evanston, Illinois
| | | | - Ruchi Gupta
- Department of Pediatrics, Northwestern University, Evanston, Illinois; Division of Academic General Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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Abstract
One of the most important causes of asthma morbidity, hospital admissions, and death is non-adherence to prescribed therapy. It is generally assumed that adherence rates can be increased with asthma education, although well conducted studies have not always supported this assumption. Education can be achieved, or can fail, in many ways and no two patients have the same needs or perceived needs. In order to better understand what children with asthma and their parents or caregivers would desire as support from their physician providers, we conducted a survey of nearly 1000 parents of asthmatic children affiliated with the Asthma and Allergy Network. Most of those who responded wanted convenient access to their doctor, more time spent in office visits with greater attention paid to the patient, help in navigating insurance and prescription costs and paperwork, and a partnership in developing care plans. Although most patients were well insured for medical coverage (not a given in the USA), half were dissatisfied with their self-reported asthma control, many were concerned about medication side effects, 60% were not cared for by an asthma specialist, and nearly half did not have an asthma action plan. These results are consistent with data from other published studies and suggest that we still can do much more to meet the needs of children for whom we provide asthma care.
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de Bruin M, Dima AL, Texier N, van Ganse E. Explaining the Amount and Consistency of Medical Care and Self-Management Support in Asthma: A Survey of Primary Care Providers in France and the United Kingdom. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1916-1925.e7. [PMID: 29753036 DOI: 10.1016/j.jaip.2018.04.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The quality of asthma primary care may vary between countries, health care practices, and health care professionals (HCPs). Identifying and explaining such differences is critical for health services improvement. OBJECTIVES To examine the quality of asthma primary care in France and United Kingdom, and identify within-country and between-country predictors amenable to intervention. METHODS An online questionnaire to capture asthma medical care and self-management support, practice characteristics, and psychosocial determinants was completed by 276 HCPs. Mokken scaling analyses were used to examine item structure and consistency. Hierarchical regression analyses were used to identify predictors of the amount (number of asthma care activities HCPs delivered) and consistency (the degree to which HCPs deliver similar care) of asthma medical care and self-management support. RESULTS On average, HCPs reported delivering 74.2% of guideline-recommended care. Consistency of medical care and self-management support was lower among HCPs delivering a lower amount of care (r = 0.58 and r = 0.57, P < .001). UK HCPs provided more and more consistent asthma self-management support-but not medical care-than French HCPs, which was explained by the presence of practice nurses in the United Kingdom. More training, positive social norms, and higher behavioral control explained better quality of care across all HCPs. CONCLUSIONS Using carefully developed questionnaires and advanced psychometric analyses, this study suggests that involving practice nurses, making social expectations visible, and providing more training to enhance skills and confidence in asthma care delivery could enhance the amount and consistency of asthma primary care. This needs to be corroborated in a future intervention trial.
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Affiliation(s)
- Marijn de Bruin
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom; Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, the Netherlands.
| | - Alexandra L Dima
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, the Netherlands
| | | | - Eric van Ganse
- Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France; Department of Pharmacoepidemiology, PELyon-EA 7425-HESPER-Claude Bernard Lyon 1 University, Lyon, France
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Gray WN, Netz M, McConville A, Fedele D, Wagoner ST, Schaefer MR. Medication adherence in pediatric asthma: A systematic review of the literature. Pediatr Pulmonol 2018; 53:668-684. [PMID: 29461017 DOI: 10.1002/ppul.23966] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To provide a systematic review of correlates of adherence to inhaled corticosteroids (ICS) in pediatric asthma across the individual, family, community, and healthcare system domains. METHODS Articles assessing medication adherence in pediatric asthma published from 1997 to 2016 were identified using PsychINFO, Medline, and CINAHL. Search terms included asthma, compliance, self-management, adherence, child, and youth. Search results were limited to articles: 1) published in the US; 2) using a pediatric population (0-25 years old); and 3) presenting original data related to ICS adherence. Correlates of adherence were categorized according to the domains of the Pediatric Self-Management Model. Each article was evaluated for study quality. RESULTS Seventy-nine articles were included in the review. Family-level correlates were most commonly reported (N = 51) and included socioeconomic status, race/ethnicity, health behaviors, and asthma knowledge. Individual-level correlates were second-most common (N = 37), with age being the most frequently identified negative correlate of adherence. Health care system correlates (N = 24) included enhanced asthma care and patient-provider communication. Few studies (N = 10) examined community correlates of adherence. Overall study quality was moderate, with few quantitative articles (26.38%) and qualitative articles (21.4%) referencing a theoretical basis for their studies. CONCLUSIONS All Pediatric Self-Management Model domains were correlated with youth adherence, which suggests medication adherence is influenced across multiple systems; however, most studies assessed adherence correlates within a single domain. Future research is needed that cuts across multiple domains to advance understanding of determinants of adherence.
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Affiliation(s)
- Wendy N Gray
- Department of Psychology, Auburn University, Auburn University, AL
| | - Mallory Netz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Andrew McConville
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - David Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Scott T Wagoner
- Department of Psychology, Auburn University, Auburn University, AL
| | - Megan R Schaefer
- Department of Psychology, Auburn University, Auburn University, AL
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Valerio MA, Peterson EL, Wittich AR, Joseph CLM. Examining health literacy among urban African-American adolescents with asthma. J Asthma 2016; 53:1041-7. [PMID: 27359106 PMCID: PMC5056364 DOI: 10.1080/02770903.2016.1175473] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 03/31/2016] [Accepted: 04/03/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This exploratory study assessed health literacy among urban African-American high school students to improve understanding of the association between adolescent health literacy and asthma. METHODS We conducted a secondary data analysis of the control group (n = 181) of the Puff City randomized controlled trial (2006-2010), a web-based intervention to promote asthma management among students, grades 9 through 12. A validated self-report 3-item health literacy screening instrument was completed at final online follow-up survey. Logistic regression was used to explore the association between health literacy, demographic characteristics, quality of life, asthma management, and health care utilization. RESULTS Multivariate analysis revealed that an overall inadequate health literacy score was associated with students who were more likely to be younger (OR 0.61; 95% CI 0.44-0.84), not on Medicaid (OR 0.36; 95% CI 0.17-0.76), have at least one hospitalization (OR 1.29; 95% CI 1.07-1.56); and a lower overall quality of life (OR 0.75; 95% CI 0.59-0.95). Those lacking confidence in filling out medical forms, needing help reading hospital materials, and having difficulty understanding written information were more likely to not have a rescue inhaler (OR 0.49; 95% CI 0.25-0.94), have one or more emergency visits (OR 1.21 95% CI 1.02-1.43), and one or more hospitalizations (OR 1.19; 95% CI 1.01-1.41), respectively. CONCLUSIONS The findings indicate a significant association between inadequate health literary and suboptimal asthma management. It is important to advance understanding of adolescent health literacy, especially those at-risk, as they assume asthma self-management tasks and move toward independent adult self-care.
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Affiliation(s)
- Melissa A Valerio
- a Health Promotion and Behavioral Science, University of Texas School of Public Health, San Antonio Regional Campus , San Antonio , TX , USA
| | - Edward L Peterson
- b Department of Public Health Sciences , Henry Ford Health System , Detroit , MI , USA
| | - Angelina R Wittich
- a Health Promotion and Behavioral Science, University of Texas School of Public Health, San Antonio Regional Campus , San Antonio , TX , USA
| | - Christine L M Joseph
- c Department of Public Health Sciences , Health Disparities Research Collaborative, Henry Ford Health System , Detroit , MI , USA
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Dima AL, de Bruin M, Van Ganse E. Mapping the Asthma Care Process: Implications for Research and Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:868-76. [PMID: 27283052 DOI: 10.1016/j.jaip.2016.04.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Whether people with asthma gain and maintain control over their condition depends not only on the availability of effective drugs, but also on multiple patient and health care professional (HCP) behaviors. Research in asthma rarely considers how these behaviors interact with each other and drug effectiveness to determine health outcomes, which may limit real-life applicability of findings. OBJECTIVE The objective of this study was to develop a logic process model (Asthma Care Model; ACM) that explains how patient and HCP behaviors impact on the asthma care process. METHODS Within a European research project on asthma (ASTRO-LAB), we reviewed asthma care guidelines and empirical literature, and conducted qualitative interviews with patients and HCPs. Findings were discussed with the project team and respiratory care experts and integrated in a causal model. RESULTS The model outlines a causal sequence of treatment events, from diagnosis and assessment to treatment prescription, drug exposure, and health outcomes. The relationships between these components are moderated by patient behaviors (medication adherence, symptom monitoring, managing triggers, and exacerbations) and HCP behaviors (medical care and self-management support). Modifiable and nonmodifiable behavioral determinants influence the behaviors of patients and HCPs. The model is dynamic as it includes feedback loops of behavioral and clinical outcomes, which influence future patient and HCP decision making. Key evidence for each relationship is summarized to derive research priorities and clinical recommendations. CONCLUSIONS The ACM model is of interest to both researchers and practitioners, and intended as a first version (ACM-v1) of a common framework for generating and translating research evidence in asthma care.
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Affiliation(s)
- Alexandra Lelia Dima
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
| | - Marijn de Bruin
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam, the Netherlands; Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, Scotland
| | - Eric Van Ganse
- Lyon Pharmaco-Epidemiology Unit, Faculte d'Odontologie, Universite Claude Bernard Lyon 1, Lyon, France; Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France
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Sheikh SI, Chrysler M, Ryan-Wenger NA, Hayes D, McCoy KS. Improving pediatric asthma care: A partnership between pediatric primary care clinics and a free-standing Children's Hospital. J Asthma 2016; 53:622-8. [PMID: 26666448 DOI: 10.3109/02770903.2015.1126845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Asthma is a common chronic disease of childhood. Providers' adherence to asthma guidelines is still less than optimal. OBJECTIVES To determine if an Asthma Education Program aimed at primary care practices can improve asthma care within practices and if the results vary by duration of the program. METHODS Ten practices were randomly assigned to an Early Asthma Education Intervention (EI) group or a Delayed Asthma Education Intervention (DI) group. The EI group received the intervention for 12 months and was monitored for 6 additional months. The DI group was observed without intervention for 12 months, then received the intervention for 6 months, and was monitored for 6 additional months. The program included training of asthma educators in each practice and then monitoring for improvement in medical record documentation of National Asthma Education and Prevention Program (NAEPP) asthma quality indicators by blinded random review of patient charts. RESULTS In the EI group, 6-, 12-, and 18-month data revealed significant improvement in documentation of asthma severity, education, action plan, night time symptoms, and symptoms with exercise compared to baseline and compared to DI group at baseline and at the 12-month interval. In the DI group, significant improvement in documentation in all of the above endpoints and also in documentation of NAEPP treatment guidelines was noted at 18 and 24 months. In both groups, documentation levels remained relatively stable at 6 months after the intervention, with no significant differences between groups. While improved, guideline adherence was <80% for half of the indicators. CONCLUSION In-office training of non-physician asthma providers improves the quality of asthma care.
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Affiliation(s)
- Shahid I Sheikh
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , Ohio , USA.,c Department of Respiratory Care , Nationwide Children's Hospital , Columbus , Ohio , USA
| | - Marjorie Chrysler
- c Department of Respiratory Care , Nationwide Children's Hospital , Columbus , Ohio , USA
| | - Nancy A Ryan-Wenger
- b Section of Pulmonary Medicine, Nationwide Children's Hospital , Columbus , Ohio , USA
| | - Don Hayes
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , Ohio , USA.,b Section of Pulmonary Medicine, Nationwide Children's Hospital , Columbus , Ohio , USA.,d Department of Internal Medicine , The Ohio State University College of Medicine , Columbus , Ohio , USA
| | - Karen S McCoy
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , Ohio , USA.,b Section of Pulmonary Medicine, Nationwide Children's Hospital , Columbus , Ohio , USA
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Lee MG, Cross KJ, Yang WY, Sutton BS, Jiroutek MR. Frequency of asthma education in primary care in the years 2007-2010. J Asthma 2015; 53:220-6. [PMID: 26313596 DOI: 10.3109/02770903.2015.1087024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Recent research suggests that health disparities persist among asthmatic patients and receipt of asthma education, though recent guidelines have highlighted the importance of receiving asthma education. The purpose of this study was to identify trends in the receipt of asthma education as well as to identify disparities in asthma education using the most recently available data in National Ambulatory Medical Care Survey, 2007-2010. METHODS Weighted chi-square tests were conducted to identify associations between asthma education and variables of interest. A weighted multivariate logistic regression model was subsequently constructed to jointly assess the association of factors of interest on receipt of asthma education. Submission to the Campbell University Institutional Review Board resulted in expedited approval. RESULTS The percentage of patients who receive asthma education remains quite low. After adjusting for all variables of interest: no statistically significant difference in receipt of asthma education between year groups (2007-2008, 2009-2010) was found (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.52-1.34); patients seen by pediatricians (vs. internal medicine physicians) and Hispanic or Latino patients (vs. non-Hispanic or Latino patients) were more likely to receive asthma education (OR 2.72, 95% CI 1.11-6.66 and OR 2.33, 95% CI 1.18-4.60, respectively); and patients not prescribed a controller medication were less likely to receive asthma education than those who were (OR 0.56, 95% CI 0.37-0.82). CONCLUSIONS Combined with previously published results, it appears the provision of asthma education continues to be low, despite proven benefits. Additionally, some patient and physician characteristics may be associated with the delivery of asthma education.
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Affiliation(s)
- Marquise G Lee
- a Department of Clinical Research , Campbell University College of Pharmacy & Health Sciences , Buies Creek , NC , USA
| | - Kevin J Cross
- a Department of Clinical Research , Campbell University College of Pharmacy & Health Sciences , Buies Creek , NC , USA
| | - Wan Yu Yang
- a Department of Clinical Research , Campbell University College of Pharmacy & Health Sciences , Buies Creek , NC , USA
| | - Beth S Sutton
- a Department of Clinical Research , Campbell University College of Pharmacy & Health Sciences , Buies Creek , NC , USA
| | - Michael R Jiroutek
- a Department of Clinical Research , Campbell University College of Pharmacy & Health Sciences , Buies Creek , NC , USA
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Carrillo G, Han D, Lucio RL, Seol YH, Chong-Menard B, Smith K. Impacting Environmental and Public Health through the Use of Dual Targeted and Tailored Asthma Educational Interventions. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2015; 2015:476173. [PMID: 26240576 PMCID: PMC4512578 DOI: 10.1155/2015/476173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/22/2015] [Indexed: 12/03/2022]
Abstract
Home-based asthma environmental education for parents of asthmatic children is needed since many health professionals lack the time to offer it. However, developing targeted and tailored education is important in order to address the individual needs of participants. This nonrandomized longitudinal study examined knowledge on asthma with an Asthma and Healthy Homes educational intervention training offered to parents of children from low income families who reside in the Rio Grande Valley of Texas. Eighty-nine parents received the training and pre- and posttest surveys were used to measure knowledge outcomes. A standardized assessment on asthma triggers was used to identify the different triggers each child was exposed to, and a follow-up survey was conducted 6 months after the educational intervention to identify how many parents reported household and behavior changes as a result of the training. Results showed significant changes in behavior by participants as a result of the training received. This study suggests that these behavioral changes are attributed to the dual "targeted" and "tailored" educational interventions delivered to parents which resulted in a greater understanding of how to manage asthma by eliminating asthma triggers in their respective homes.
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Affiliation(s)
- Genny Carrillo
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M Health Science Center, College Station, TX 77843, USA
| | - Daikwon Han
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M Health Science Center, 1266 TAMU, College Station, TX 77843, USA
| | - Rose L. Lucio
- Texas A&M Health Science Center, McAllen Campus, 2101 South McColl Road, McAllen, TX 78503, USA
| | - Yoon-Ho Seol
- Department of Health Informatics, Georgia Regents University, Augusta, GA 30912-0400, USA
| | - Betty Chong-Menard
- Clinical Education, Respiratory Therapy Program, South Texas College, Dr. Ramiro R. Casso Nursing & Allied Health Campus, 1101 E. Vermont, McAllen, TX 78503, USA
| | - Kenneth Smith
- Respiratory Therapy Services, Rio Grande Regional Hospital, 101 E. Ridge Road, McAllen, TX 78503, USA
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Pieters L, Vijverberg S, Raaijmakers J, van der Ent K, Maitland-van der Zee AH. Astmadiagnose bij kinderen. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s12445-014-0234-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Britto MT, Vockell ALB, Munafo JK, Schoettker PJ, Wimberg JA, Pruett R, Yi MS, Byczkowski TL. Improving outcomes for underserved adolescents with asthma. Pediatrics 2014; 133:e418-27. [PMID: 24470645 DOI: 10.1542/peds.2013-0684] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Asthma is the most common chronic disease of childhood. Treatment adherence by adolescents is often poor, and their outcomes are worse than those of younger patients. We conducted a quality improvement initiative to improve asthma control and outcomes for high-risk adolescents treated in a primary care setting. METHODS Interventions were guided by the Chronic Care Model and focused on standardized and evidence-based care, care coordination and active outreach, self-management support, and community connections. RESULTS Patients with optimally well-controlled asthma increased from ∼10% to 30%. Patients receiving the evidence-based care bundle (condition/severity characterized in chart and, for patients with persistent asthma, an action plan and controller medications at the most recent visit) increased from 38% to at or near 100%. Patients receiving the required self-management bundle (patient self-assessment, stage-of-readiness tool, and personal action plan) increased from 0% to ∼90%. Patients and parents who were confident in their ability to manage their or their adolescent's asthma increased from 70% to ∼85%. Patient satisfaction and the mean proportion of patients with asthma-related emergency department visits or hospitalizations remained stable at desirable levels. CONCLUSIONS Implementing interventions focused on standardized and evidence-based care, self-management support, care coordination and active outreach, linkage to community resources, and enhanced follow-up for patients with chronically not-well-controlled asthma resulted in sustained improvement in asthma control in adolescent patients. Additional interventions are likely needed for patients with chronically poor asthma control.
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Affiliation(s)
- Maria T Britto
- Division of Adolescent Medicine, Center for Innovation in Chronic Disease Care
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Grover C, Armour C, Van Asperen PP, Moles RJ, Saini B. Medication use in Australian children with asthma: user's perspective. J Asthma 2013; 50:231-41. [PMID: 23305726 DOI: 10.3109/02770903.2012.757778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Medication use-related issues remain problematic in childhood asthma despite effective treatment strategies and public investment into improved asthma management strategies in industrialized countries. This study aimed to carry out an in-depth exploration of the views of parents/carers and children with asthma on medication use. METHODS Semi-structured qualitative interviews were conducted with a purposive convenience sample of children with asthma and their parents recruited from general practices in Sydney. Interviews were tape-recorded, transcribed verbatim, and thematically analyzed. RESULTS A total of 52 interviews (26 parents/carers and 26 children with asthma) were conducted. Major themes which emerged from the children's interviews included issues such as self-image, resistance to medication use, and lack of responsibility in medication taking. Parental or carer issues included lack of clear understanding of how medications worked, as well as administration difficulties, cost constraints, and beliefs about medications contrary to quality use. DISCUSSION This is one of the few research studies exploring the viewpoint of children with asthma about their medications in Australia. Despite investment in dissemination of professional, targeted evidence-based asthma management strategies in healthcare, there seems to be a lack of depth in terms of what parents understand about their child's asthma. Effective communication about medication usage, especially the inclusion of the child in the consultation to empower them to be involved in their own asthma care, may be the answer.
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Affiliation(s)
- Charu Grover
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
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