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Long HM, Cobb KA, Leisenring PA, King SE, Willis LD, Pesek RD, Berlinski A. Implementation of a Respiratory Therapist-Driven Protocol for Spirometry and Asthma Education in a Pediatric Out-Patient Primary Care Setting. Respir Care 2023; 68:1195-1201. [PMID: 37193600 PMCID: PMC10468161 DOI: 10.4187/respcare.10930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Best practice guidelines for asthma management recommend education and spirometry at specific intervals. A written asthma action plan with education and spirometry is ordered at the discretion of physicians at our institution. An initial chart review revealed that asthma education and spirometry were not consistently ordered in the pediatric primary care clinics. This quality improvement study aimed to increase frequency of spirometry and asthma education in children with asthma seen in pediatric primary care through use of a respiratory therapist (RT)-driven protocol. METHODS The protocol established that spirometry and education would be done annually for children ≥ 6 y of age with intermittent asthma and every 6 months for persistent asthma. RTs identified eligible subjects and placed the electronic medical record orders before the clinic visit. Physicians were invited to complete a questionnaire before and after protocol implementation to assess barriers and protocol satisfaction. RESULTS Nine hundred and thirty-two children were included. Prior to protocol implementation, spirometry and education were completed in 64.9% and 62.6% of eligible children, respectively. Following protocol implementation, spirometry and education were significantly increased to 92.7% (P < .001) and 88.5% (P < .001), respectively. Physicians identified interruption in clinic flow as the primary barrier for ordering spirometry and were satisfied with the protocol. Physicians stated that communication with RT improved through use of this protocol. CONCLUSIONS Implementation of an RT-driven protocol in an out-patient pediatric primary care setting significantly increased utilization of spirometry and education for children with asthma. RTs working in the pediatric out-patient primary care setting played a vital role in achieving best practices for asthma management. The implementation of the protocol enhanced interdisciplinary communication.
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Affiliation(s)
- Haley M Long
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Kim A Cobb
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Pam A Leisenring
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Sandy E King
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas
| | - L Denise Willis
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Robert D Pesek
- Department of Pediatrics, Allergy and Immunology, University of Arkansas for Medical Sciences Little Rock, Arkansas
| | - Ariel Berlinski
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas; Department of Pediatrics, Pulmonary and Sleep Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and Pediatric Aerosol Research Laboratory, Arkansas Children's Research Institute, Little Rock, Arkansas.
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Suzuki D, Saito-Abe M, Matsumoto Y, Umezawa K, Takada K, Toyokuni K, Ishikawa F, Hirai S, Sato M, Miyaji Y, Morita H, Hamaguchi S, Kabashima S, Fukuie T, Nomura I, Yamamoto-Hanada K, Ohya Y. [A CASE OF INDUCIBLE LARYNGEAL OBSTRUCTION UNSUCCESSFULLY TREATED AS SEVERE ASTHMA WAS WELL CONTROLLED AFTER APPROPRIATE DIAGNOSIS AND INSTRUCTION OF THERAPEUTIC BREATHING MANEUVERS]. Arerugi 2023; 72:44-48. [PMID: 36792160 DOI: 10.15036/arerugi.72.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Inducible laryngeal obstruction (ILO) refers to respiratory disorders caused by airflow limitation in the larynx, including vocal cord dysfunction, and may sometimes be misdiagnosed as bronchial asthma (BA). Here, we report the case of an 11-year-old boy diagnosed with BA in infancy. He was referred to our Allergy Center and was taking a high dose of inhaled corticosteroids (ICS) due to frequent coughing from the age of 10 years and persistent coughing following COVID-19 infection at the age of 11. However, the patient continued to experience frequent coughing attacks and repeated visits to the emergency department after inhalation of β2-stimulants failed to improve his cough. We admitted him to the allergy center for examinations to assess the BA severity. In the airway hypersensitiveness test, saline inhalation performed prior to methacholine inhalation caused expiratory stridor and respiratory distress in the larynx, which worsened with β2-stimulant inhalation. Based on these results, we ruled out BA and diagnosed ILO. We instructed him on breathing maneuvers, and he was able to respond appropriately when symptoms appeared. We then started reducing his ICS dose.
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Affiliation(s)
- Daichi Suzuki
- Allergy Center, National Center for Child Health and Development
| | - Mayako Saito-Abe
- Allergy Center, National Center for Child Health and Development
| | | | - Kotaro Umezawa
- Allergy Center, National Center for Child Health and Development
| | - Kazuma Takada
- Allergy Center, National Center for Child Health and Development
| | - Kenji Toyokuni
- Allergy Center, National Center for Child Health and Development
| | - Fumi Ishikawa
- Allergy Center, National Center for Child Health and Development
| | - Seiko Hirai
- Allergy Center, National Center for Child Health and Development
| | - Miori Sato
- Allergy Center, National Center for Child Health and Development
| | - Yumiko Miyaji
- Allergy Center, National Center for Child Health and Development
| | - Hideaki Morita
- Allergy Center, National Center for Child Health and Development
| | - Sayaka Hamaguchi
- Allergy Center, National Center for Child Health and Development
| | | | - Tatsuki Fukuie
- Allergy Center, National Center for Child Health and Development
| | - Ichiro Nomura
- Allergy Center, National Center for Child Health and Development
| | | | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development
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3
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Wilkins R, Schiffmacher S, Gatewood A, Conway L, Greiner B, Hartwell M. Asthma medications in schools: a cross-sectional analysis of the Asthma Call-back Survey 2017-2018. J Osteopath Med 2022; 122:581-586. [PMID: 35918304 DOI: 10.1515/jom-2022-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/15/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT Asthma is the most common chronic disease affecting children in the United States. Goals for asthma management include symptom control, the ability to maintain a normal activity level, and minimizing adverse events. OBJECTIVES The objective of this study is to analyze the number of children with asthma that are permitted to carry medications at school and without an asthma action plan. METHODS In this study, we analyzed the Center for Disease Control and Prevention (CDC) Asthma Call-back Survey (ACBS) to assess the prevalence of children in school allowed to carry medication and with asthma action plans. Utilizing the sampling weights provided, we estimated population prevalence by age group and urbanicity. RESULTS Results showed that, overall, 34.8% of students reported they were not allowed to carry asthma medications in school. Specifically, nearly 51% of children ages 5 to 9 and 33% of children ages 10 to 14 were reported not to be allowed to carry medications at school. Further, 58.2% of children did not have a written asthma action plan. Reported urbanicity was not significantly associated with access to medication at school (p=0.46) or having an asthma action plan (p=0.57). CONCLUSIONS In our study, more than one-third of students were not permitted to carry asthma medications and nearly three-fifths did not have a written asthma action plan. Therefore, we recommend partnerships between schools, healthcare professionals, students, and osteopathic family physicians to increase access to asthma action plans and medication in schools.
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Affiliation(s)
- Rachel Wilkins
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
| | - Sadie Schiffmacher
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
| | - Ashton Gatewood
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Lauren Conway
- Department of Pediatrics, University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Ben Greiner
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Micah Hartwell
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Afolabi T, Fairman KA. Association of Asthma Exacerbation Risk and Physician Time Expenditure With Provision of Asthma Action Plans and Education for Pediatric Patients. J Pediatr Pharmacol Ther 2022; 27:244-253. [PMID: 35350158 DOI: 10.5863/1551-6776-27.3.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/14/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To provide information about factors underlying provision of asthma action plans (AAPs) to a minority of pediatric patients with asthma, assess whether risk of exacerbation acts on provision of AAP and asthma education directly, suggesting targeting to highest-risk patients, or indirectly by influencing physician-patient interaction time. METHODS This study was a retrospective cross-sectional analysis of a nationally representative sample of physician office visits that consisted of patients aged 2 to 18 years with asthma. Exacerbation risk comprised proxy indicators of control and severity. Direct and time-mediated effects of exacerbation risk on provision of AAP and education were calculated from logistic regression models. RESULTS Asthma action plans were provided in 14.3% of visits, education in 23.9%. Total direct effects of exacerbation risk (ORs = 3.88-4.69) far exceeded indirect, time-mediated effects (both ORs = 1.03) on AAPs. Direct effects on education were similar but smaller. After adjusting for risk, physician time expenditure of ≥30 minutes was associated with nearly doubled odds of providing AAP or education (ORs = 1.90-1.99). Visits that included allied health professionals alongside physician care were significantly associated with all 4 outcomes in multivariate analyses (ORs = 3.06-5.28). CONCLUSIONS Exacerbation risk has a strong, direct association with AAP provision in pediatric asthma, even controlling for physician time expenditure. Provision of AAP and education to pediatric patients with asthma may be facilitated by increasing available time for office visits and involving allied health professionals.
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Affiliation(s)
- Titilola Afolabi
- Midwestern University College of Pharmacy-Glendale (TA, KAF), Glendale, AZ.,Phoenix Children's Hospital (TA), Phoenix, AZ
| | - Kathleen A Fairman
- Midwestern University College of Pharmacy-Glendale (TA, KAF), Glendale, AZ
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Prigge K, Holtz KK, Mara K, Meek A. Providing Asthma Management in the Retail Clinic Setting. J Prim Care Community Health 2022; 13:21501319221092256. [PMID: 35465761 PMCID: PMC9036326 DOI: 10.1177/21501319221092256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To determine whether there are differences in asthma management provided in the retail clinic setting versus in the primary care setting, and whether it would increase the number of well controlled asthmatics as determined by ACT score of 20 or greater, and less than or equal to 1 ED or hospital visit due to asthma, within 6 months. Methods: All asthma patients with an asthma control test (ACT) of 19 or less, received a new or updated asthma action plan (AAP) at the visit. If the patient presented to the retail clinic during an asthma exacerbation or with any asthma symptoms, they were not given an ACT and received usual care. Asthma quality data was retrospectively collected for primary care patients seen in the 6-months prior to as well as up to 6 months after the patient’s enrollment visit. Results: There was no significant difference in the number of admissions between locations in either the pre-implementation period or the post-implementation period for either the pediatric or adult cohort. There was a significant improvement in the percentage of pediatric and adult patients with at least 1 ACT in the post-implementation compared to pre-implementation for both retail clinic and primary care sites. The percentage of pediatric and adult patients with at least 1 AAP increased in the post-implementation compared to pre-implementation for both retail clinic and primary care sites. Conclusion: Retail clinics may be able to provide asthma management with similar outcomes to primary care settings.
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Pletta KH, Kerr BR, Eickhoff JC, Allen GS, Jain SR, Moreno MA. Pediatric Asthma Action Plans: National Cross-Sectional Online Survey of Parents' Perceptions. JMIR Pediatr Parent 2020; 3:e21863. [PMID: 33164900 PMCID: PMC7683255 DOI: 10.2196/21863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/08/2020] [Accepted: 10/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Asthma Action Plans (AAPs) are recommended for pediatric patients to help improve asthma control. Studies have shown variable results for unscheduled doctor and emergency room visits. AAPs may have an impact on parental self-efficacy for asthma management as well as on other daily living factors that are valuable for patients and families, such as the number of missed school days and parental workdays, and on school and caregiver management. OBJECTIVE The purpose of this study is to understand parent perceptions of AAPs. The goals of this analysis were threefold, including examining (1) the association between pediatric AAPs and parental self-efficacy, (2) parent perceptions of the helpfulness of an AAP for daily living factors, and (3) associations with the type of provider who gave the AAP (a primary care provider or an asthma specialist). METHODS A national cross-sectional online survey was completed in October 2018 by parents of children with asthma aged 0-17 years. Survey questions included the presence or absence of a pediatric AAP, the Bursch Parental Self-efficacy for Asthma scale, parental perceptions of the AAP's helpfulness with regard to daily living factors ranked on a 5-point Likert scale, and the provider type who gave the AAP. Survey responses were summarized in terms of percentages or means and standard deviations. A 2-sample t test and analysis of covariance were used to compare self-efficacy for asthma and parental-perception-of-helpfulness scores between subjects with an AAP versus subjects without an AAP. All reported P values were 2-sided. RESULTS A total of 704 parents with a child with asthma completed the survey. The parents had a mean age of 37.5 years (SD 10.9), and 82% (577/704) were women and 18% (127/704) were men. Most (564/704, 80%) parents had an AAP for their child; 65% (367/564) were written, 51% (286/564) were online, and 84% (474/564) were available at school. The Bursch Self-efficacy scale was significantly higher for parents with an AAP (mean 57.7, SD 8.6) versus no AAP (mean 55.1, SD 9.9; P<.001). Parents reported that they agreed/strongly agreed that an AAP was helpful for daily living factors, including managing asthma (446/544, 82%), decreased parental missed workdays (367/544, 68%), decreased child missed-school days (396/542, 73%), and for when a child is at school (422/541 78%), with other caregivers (434/543, 80%), doing normal activities (421/540 78%), and leading a normal life (437/540 81%). Parents agreed/strongly agreed that an AAP was helpful from all provider types: a pediatric provider (583/704, 82.8%), a family practice provider (556/704, 79%), and an asthma specialist (594/704, 84.4%). There was no significant difference (P=.53) between the type of provider who gave the AAP. CONCLUSIONS Parents who had pediatric AAPs for their children reported increased parental self-efficacy compared to those who did not have AAPs. Parents found AAPs helpful for decreasing missed time from work and school, and for asthma management when at home, school, and with other caregivers. Significant AAP helpfulness was seen regardless of the provider who gave the AAP, the parent's education, and income level. Findings support the usefulness of pediatric AAPs for families and the development of easily sharable electronic AAPs for children.
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Affiliation(s)
- Karen H Pletta
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Bradley R Kerr
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Jens C Eickhoff
- Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, United States
| | - Gail S Allen
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Sanjeev R Jain
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Megan A Moreno
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
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7
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Asthma is a leading cause of chronic illness among school-aged children and adolescents. Current trends have led to school faculty and staff becoming increasingly responsible for managing student asthma, often without optimal training or resources. The purpose of this project was to establish whether facilitated access to personalized student asthma action plans (AAPs), education, proper use, and school nurse support improved reported self-efficacy regarding student asthma exacerbation prevention and management in elementary and preschool faculty and staff. Thirty-five participants from an urban, underserved Connecticut school were surveyed to determine perceived self-efficacy regarding student asthma exacerbation prevention and management. AAPs were then placed with students' asthma inhalers, and all participants were instructed on their use. Three months later, participants were resurveyed. A statistically significant difference after both the initial education and 3-month survey was identified. Providing elementary and preschool faculty and staff with facilitated access to student action plans and education on their use can improve perceived self-efficacy regarding student asthma exacerbation prevention and management.
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Affiliation(s)
| | - Casey Norris
- The University of Alabama in Huntsville, TX, USA
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Weinberger SJ, Cowan KJ, Robinson KJ, Pellegrino CA, Frankowski BL, Chmielewski MV, Shaw JS, Harder VS. A primary care learning collaborative to improve office systems and clinical management of pediatric asthma. J Asthma 2019; 58:395-404. [PMID: 31838923 DOI: 10.1080/02770903.2019.1702199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Pediatric asthma is a common, relapsing-remitting, chronic inflammatory airway disease that when uncontrolled often leads to substantial patient and health care system burden. Improving management of asthma in primary care can help patients stay well controlled. METHODS The Vermont Child Health Improvement Program (VCHIP) developed a quality improvement (QI) learning collaborative with a primary objective to improve clinical asthma management measures through improvement in primary care office systems to support asthma care. Seven months of medical record review data were evaluated for improvements on eight clinical asthma management measures. Pre and post office systems inventory (OSI) self-assessments detailing adherence to improvement strategies were analyzed for improvement. Logistic regressions were used to test for associations between OSI strategy post scores and the corresponding clinical asthma management measures by month seven. RESULTS This study found significant improvement from baseline to month seven on seven of the eight clinical asthma management measures and between pre and post OSI for seven of the nine strategies assessed (N = 19 practices). Additionally, one point higher average OSI scores on the assessment and monitoring of asthma severity, asthma control, asthma action plans, and asthma education strategies were associated with significantly greater odds of improvement in their respective clinical asthma management measures. CONCLUSIONS A QI learning collaborative approach in primary care can improve office systems and corresponding clinical management measures for pediatric patients with asthma. This suggests that linking specific office systems strategies to clinical measures may be a helpful tactic within the learning collaborative model.
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Affiliation(s)
- Stanley J Weinberger
- Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, USA.,Pediatric Primary Care, University of Vermont Children's Hospital, Burlington, VT, USA
| | - Kelly J Cowan
- Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, USA.,Pediatric Pulmonology, University of Vermont Children's Hospital, Burlington, VT, USA
| | - Keith J Robinson
- Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, USA.,Pediatric Pulmonology, University of Vermont Children's Hospital, Burlington, VT, USA
| | | | - Barbara L Frankowski
- Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, USA.,Pediatric Primary Care, University of Vermont Children's Hospital, Burlington, VT, USA
| | | | - Judith S Shaw
- Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Valerie S Harder
- Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, USA
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Urquhart A, Clarke P. US racial/ethnic disparities in childhood asthma emergent health care use: National Health Interview Survey, 2013-2015. J Asthma 2019; 57:510-520. [PMID: 30958048 DOI: 10.1080/02770903.2019.1590588] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Racial/ethnic disparities in Emergency Department (ED) visits due to childhood asthma are well documented. We assessed disparities among multiple racial/ethnic groups and examined the effects of asthma management in emergent health care use among children in the United States.Methods: Data come from the sample child component of the 2013-2015 National Health Interview Survey (NHIS) (ages 2-17). Among children with current asthma, (N = 3336) we assessed racial/ethnic disparities in ED visits due to asthma in the past 12 months. We used multivariate logistic regression to calculate model adjusted odds ratios (ORs) including adjustment of asthma management questions available in NHIS 2013: use of an asthma action plan, preventative medication use, and an asthma management course.Results: Using 2013-2015 NHIS data, Puerto Rican children had the highest prevalence of current asthma (21.2%). Among children with asthma, significantly higher odds of ED visits were seen among all minority subgroups (except non-Hispanic other) compared to non-Hispanic white children with Hispanic other having the highest adjusted odds ratio (OR = 2.4), followed by Puerto Rican (OR = 2.0), Mexican American (OR = 1.8) and non-Hispanic black children (OR = 1.7). In sub analyses using 2013 data, adjustment of management measures resulted in a modest to no effect in the odds of having an ED visit due to asthma.Conclusions: The high prevalence of asthma and the disparity in asthma related ED visits among minority children exemplify the need for further research in understanding the mechanisms underlying the continuing existence of these health imbalances.
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Affiliation(s)
- Audrey Urquhart
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Philippa Clarke
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Tan DJ, Burgess JA, Perret JL, Bui DS, Abramson MJ, Dharmage SC, Walters EH. Non-pharmacological management of adult asthma in Australia: cross-sectional analysis of a population-based cohort study. J Asthma 2018; 57:105-112. [PMID: 30569783 DOI: 10.1080/02770903.2018.1545030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim: To identify the level of non-pharmacological care received by middle-aged adults with current asthma in Australia and to identify its association with clinical measures. Methods: The Tasmanian Longitudinal Health Study (TAHS) is a population-based cohort first studied in 1968 (n = 8583). In 2010, when participants were aged 49 years, a stratified sample enriched for asthma and bronchitis underwent clinical assessments including respiratory questionnaires and lung function testing (n = 836). Current asthma was defined as self-reported asthma symptoms and/or healthcare utilization in the last 12 months. Multivariable linear regression and log-binomial models were used to assess the relevant associations. Results: Of the entire TAHS cohort, 15.6% (95% CI 13.4-18.2%) had current asthma. Of these, 37.9% (95% CI 30.5-45.9%) had seen a general practitioner for their asthma and 16.5% (95% CI 11.5-23.1%) had discussed their asthma with a pharmacist in the last 12 months. Written asthma action plans (AAPs) were reported by 17.9% (95% CI 12.9-23.2%), verbal AAPs by 53.8% (95% CI 45.9-61.6%) and doctor-assessments of inhaler technique by 42.7% (95% CI 35.2-50.5%). Adults with asthma of greater severity were more likely to have received verbal AAPs (p-trend =0.02). In contrast, adults with lower spirometry were more likely to have received verbal AAPs (p = 0.04), written AAPs (p = 0.001) and education on inhaler technique (p = 0.04). Conclusion: Despite an established evidence base and recommendations in local and international guidelines, non-pharmacological asthma management remains sub-optimal in the middle-aged adult asthma population.
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Affiliation(s)
- Daniel J Tan
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,The Alfred Hospital, Melbourne, Victoria, Australia
| | - John A Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dinh S Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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12
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Haas-Howard C, Schoessler S. Caring for the Student With Asthma at School: What's Out There to Help the School Nurse? NASN Sch Nurse 2018; 33:84-86. [PMID: 29452552 DOI: 10.1177/1942602x18754776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Asthma is a high impact health issue in the school setting. One in 10 children comes to school with asthma, and it is the leading cause for absenteeism causing 13.8 million missed school days each year. Where can the school nurse turn for help? The following article provides evidence-based resources to assist school nurses in caring for their students with asthma.
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Affiliation(s)
- Christy Haas-Howard
- Asthma Nurse Specialist, Department of Nursing & Student Health Services, Denver, CO
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Lemanske RF, Kakumanu S, Shanovich K, Antos N, Cloutier MM, Mazyck D, Phipatanakul W, Schantz S, Szefler S, Vandlik R, Williams P. Creation and implementation of SAMPRO™: A school-based asthma management program. J Allergy Clin Immunol 2017; 138:711-723. [PMID: 27596707 PMCID: PMC5085063 DOI: 10.1016/j.jaci.2016.06.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 05/23/2016] [Accepted: 06/03/2016] [Indexed: 11/25/2022]
Abstract
Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a “circle of support” that would enhance multidirectional communication and promote better care for children with asthma within the school setting.
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Affiliation(s)
- Robert F Lemanske
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Sujani Kakumanu
- University of Wisconsin School of Medicine and Public Health and the Middleton Memorial Veteran's Hospital, Madison, Wis
| | - Kathleen Shanovich
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Nicholas Antos
- Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wis
| | - Michelle M Cloutier
- Department of Pediatrics, University of Connecticut Health Center, Farmington, and the Asthma Center, CT Children's Medical Center, Hartford, Conn
| | - Donna Mazyck
- National Association of School Nurses, Silver Spring, Md
| | - Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, Harvard Medical School, Boston, Mass
| | | | - Stanley Szefler
- Children's Hospital Colorado, the Breathing Institute, and Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Renee Vandlik
- American Academy of Allergy, Asthma & Immunology, Milwaukee, Wis
| | - Paul Williams
- Department of Pediatrics, University of Washington School of Medicine, Allergist, NW Asthma & Allergy Center, Seattle, Wash
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Greenberg J, Prushinskaya O, Harris JD, Guidetti-Myers G, Steiding J, Sawicki GS, Gaffin JM. Utilization of a patient-centered asthma passport tool in a subspecialty clinic. J Asthma 2017; 55:180-187. [PMID: 28548904 DOI: 10.1080/02770903.2017.1323916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Despite available and effective tools for asthma self-assessment (Asthma Control Test, ACT) and self-management (Asthma Action Plan, AAP), they are underutilized in outpatient specialty clinics. We evaluated the impact of a patient-centered checklist, the Asthma Passport, on improving ACT and AAP utilization in clinic. METHODS This was a randomized, interventional quality-improvement project in which the Asthma Passport was distributed to 120 pediatric asthma patients over the duration of 16 weeks. The passport's checklist consisted of tasks to be completed by the patient/family, including completion of the ACT and AAP. We compared rates of completion of the ACT and AAP for those who received the passport versus the control group, and assessed patient/caregiver and provider satisfaction. RESULTS Based on electronic medical record data from 222 participants, the ACT completion rate was not significantly different between the passport and control groups, however, the AAP completion rate was significantly greater than control (30.0% vs. 17.7%, p = 0.04). When per-protocol analysis was limited to groups who completed and returned their passports, ACT and AAP completion rates were significantly greater than control (73.8% vs. 44.1% (p = 0.002) and 35.7% vs. 17.7% (p = 0.04), respectively). Nearly all participants reported high satisfaction with care, and surveyed providers viewed the passport favorably. CONCLUSIONS A patient-centered checklist significantly improved the completion rate of the AAP. For patient's who completed and returned the asthma passport, the ACT completion rate was also improved. Participants and providers reported high satisfaction with the checklist, suggesting that it can effectively promote asthma self-management and self-assessment without burdening clinicians or clinic workflow.
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Affiliation(s)
- Jonathan Greenberg
- a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
| | - Olga Prushinskaya
- a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
| | - Joshua D Harris
- a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
| | | | - Jacqueline Steiding
- a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
| | - Gregory S Sawicki
- a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
| | - Jonathan M Gaffin
- a Division of Respiratory Diseases , Boston Children's Hospital , Boston , MA , USA
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Young CA, Stookey J, Patel AI, Chan C, Evans J, Cohn K, Agana L, Yen IH, Fernandez A, Cabana MD. San Francisco childcare centers' preparedness in the prevention and management of asthma among preschool-aged children. J Asthma 2016; 53:691-8. [PMID: 27164036 PMCID: PMC5814296 DOI: 10.3109/02770903.2015.1135944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/21/2015] [Accepted: 12/21/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Asthma is a common health condition for children in childcare. National recommendations for asthma in childcare exist. However, no studies have investigated the extent to which childcare centers adhere to these recommendations. We aimed to assess childcare center adherence to National Asthma Education and Prevention Program (NAEPP) recommendations for asthma care and preparedness and to identify characteristics associated with increased adherence to national asthma recommendations. METHODS We developed a standardized instrument. Each childcare center received a score of 0 through 7 based on number of recommendations met. We conducted t-tests, chi square tests and linear regression to identify childcare center factors associated with increased asthma preparedness. RESULTS 36 out of 40 eligible childcare centers (90%) participated. These sites served 1570 children primarily between the ages of 2 to 5 years. On average, centers met 3.8 out of 7 (SD = 1.3) recommendations. Staff familiarity caring for children with asthma (p < 0.001) and the center's asthma prevalence (p = 0.01) was positively associated with the center's asthma preparedness. The 3 areas most in need of improvement related to asthma medications, asthma action plans and asthma policies. None of the managers reported being familiar with the NAEPP recommendations. DISCUSSION There is room for improvement in the asthma care and preparedness of childcare centers. The 3 areas in which centers performed poorly (appropriate asthma medication management, use of asthma action plans, and presence of appropriate asthma policies) suggest that closer collaboration between clinicians and childcare centers may be a key to improving asthma management for young children.
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Affiliation(s)
- Chelsea A. Young
- University of California, San Francisco, Department of Psychiatry, San Francisco, California
| | - Jodi Stookey
- Maternal, Child and Adolescent Health, San Francisco Department of Public Health, San Francisco, California
| | - Anisha I. Patel
- University of California, San Francisco, Department of Pediatrics, San Francisco, California
- Philip R Lee Institute of Health Policy Studies, University of California, San Francisco, California
| | - Curtis Chan
- Maternal, Child and Adolescent Health, San Francisco Department of Public Health, San Francisco, California
| | - Jane Evans
- Maternal, Child and Adolescent Health, San Francisco Department of Public Health, San Francisco, California
| | - Karen Cohn
- Children's Environmental Health, San Francisco Department of Public Health, San Francisco, California
| | - Luz Agana
- Children's Environmental Health, San Francisco Department of Public Health, San Francisco, California
| | - Irene H. Yen
- Internal Medicine, University of California, San Francisco
| | | | - Michael D. Cabana
- University of California, San Francisco, Department of Pediatrics, San Francisco, California
- Philip R Lee Institute of Health Policy Studies, University of California, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
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Simon AE, Akinbami LJ. Asthma Action Plan Receipt among Children with Asthma 2-17 Years of Age, United States, 2002-2013. J Pediatr 2016; 171:283-9.e1. [PMID: 26858189 PMCID: PMC6713192 DOI: 10.1016/j.jpeds.2016.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/01/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine national trends in the receipt of asthma action plans, an intervention recommended by the National Asthma Education and Prevention Program guidelines. STUDY DESIGN We used data from the sample child component of the National Health Interview Survey from 2002, 2003, 2008, and 2013 to examine the percentage of children 2-17 years of age with asthma (n = 3714) that have ever received an asthma action plan. Bivariate and multivariate (with adjustment for sociodemographic characteristics and asthma outcomes consistent with greater disease severity) logistic regressions were conducted to examine trends from 2002 to 2013 and to examine, with 2013 data only, the relationship between having received an asthma action plan and both sociodemographic characteristics and indicators of asthma severity. RESULTS The percentage of children with asthma that had ever received an asthma action plan increased from 41.7% in 2002 to 50.7% in 2013 (P < .001 for trend). In 2013, a greater percentage of non-Hispanic black (58.4%) than non-Hispanic white (47.4%) children (P = .028), privately insured (56.2%) vs those with public insurance only (46.3%) (P = .016), and users of inhaled preventive asthma medication vs those that did not (P < .001) had ever received an asthma action plan. Adjusted results were similar. CONCLUSION The percentage of US children with asthma that had ever received an asthma action plan increased between 2002 and 2013, although one-half had never received an asthma action plan in 2013. Some sociodemographic and asthma severity measures are related to receipt of an asthma action plan.
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Affiliation(s)
- Alan E. Simon
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Lara J. Akinbami
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD,United States Public Health Service, Rockville, MD
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Burbank AJ, Lewis SD, Hewes M, Schellhase DE, Rettiganti M, Hall-Barrow J, Bylander LA, Brown RH, Perry TT. Mobile-based asthma action plans for adolescents. J Asthma 2015; 52:583-6. [PMID: 25494553 DOI: 10.3109/02770903.2014.995307] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine feasibility and utilization of a mobile asthma action plan (AAP) among adolescents. METHODS Adolescents (aged 12-17 years) with persistent asthma had their personalized AAP downloaded to a smartphone application. Teens were prompted by the mobile application to record either daily symptoms or peak flow measurements and to record medications. Once data were entered, the application provided immediate feedback based on the teen's AAP instructions. Asthma Control Test (ACT(®)) and child asthma self-efficacy scores were examined pre- and post-intervention. RESULTS Adolescents utilized the mobile AAP a median 4.3 days/week. Participant satisfaction was high with 93% stating that they were better able to control asthma by utilizing the mobile AAP. For participants with uncontrolled asthma at baseline, median (interquartile range) ACT scores improved significantly from 16 (5) to 18 (8) [p = 0.03]. Median asthma attack prevention self-efficacy scores improved from 34 (3.5) to 36 (5.3) [p = 0.04]. CONCLUSIONS Results suggest that personalized mobile-based AAPs are a feasible method to communicate AAP instructions to teens.
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Affiliation(s)
- Allison J Burbank
- a Department of Pediatrics , University of Arkansas for Medical Sciences , Little Rock , AR , USA
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Hanson TK, Aleman M, Hart L, Yawn B. Increasing availability to and ascertaining value of asthma action plans in schools through use of technology and community collaboration. J Sch Health 2013; 83:915-920. [PMID: 24261526 DOI: 10.1111/josh.12110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Approximately 9% of school-aged children in the United States have asthma. Since 1997, the Asthma Action Plan (AAP) has been recommended as an asthma self-management tool for individuals with asthma. In the school setting, the use of the AAP has been primarily dependent on communication between the family and the school through a paper process. METHODS To address the limited availability of AAPs, the Southeast Minnesota Beacon Project developed and implemented a secure portal designed for the electronic exchange of the AAP between providers and schools. This project was designed to assess school nurses' responses to the portal and the perceived value of AAPs, efficiency, self-efficacy, and project impact. RESULTS School nurses perceive that the AAP enables more efficient management of the care of students with asthma and increases school nurse self-efficacy in regard to asthma management. Overall, school nurses felt the AAP portal was useful and they reported satisfaction with its function as a school health office resource. CONCLUSION Electronic sharing of the AAP has the potential to increase efficiency and enhance effective communication among health care providers, families, and schools.
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Affiliation(s)
- Tabitha K Hanson
- Licensed School Nurse, , Rochester Public Schools, 334 16th St. SE, Rochester, MN 55904
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Egginton JS, Textor L, Knoebel E, McWilliams D, Aleman M, Yawn B. Enhancing school asthma action plans: qualitative results from southeast Minnesota beacon stakeholder groups. J Sch Health 2013; 83:885-895. [PMID: 24261523 DOI: 10.1111/josh.12107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 09/11/2012] [Indexed: 06/02/2023]
Abstract
BACKGROUND This study explores ways southeast Minnesota schools currently address asthma problems, identifies areas for improvement, and assesses the potential value of asthma action plans (AAPs) in schools. METHODS Focus groups were used to query stakeholder groups on asthma care in schools. Groups were held separately for elementary school personnel, parents of elementary school children with asthma, and health professionals (N = 103). Transcripts were analyzed by hand and by using NVivo 9 software. RESULTS Overall 103 stakeholders participated in focus groups. Major themes were (1) Communication; no uniform way of exchanging information between schools and health professionals. (2) Asthma Control Continuum; students require individualized instructions and information related to their asthma care. (3) Policy/Protocol; school staff roles and rules vary and are unclear. (4) Self-Reliance; older children self-manage their asthma and are unknown until they need emergent support. Solution recommended included AAPs used systematically with a method to communicate back from schools to physicians and parents. CONCLUSIONS The AAP may solve several of the school's concerns regarding their ability to provide asthma support in school. However, the AAP must reach the school, and that is currently not happening. In addition, schools would like tools and systems to assess asthma control and share information back with parents and physicians.
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Affiliation(s)
- Jason S Egginton
- Research Assistant, , Mayo Clinic, 200 1st Street SW, Rochester, MN 55905
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Arguel A, Lau AY, Dennis S, Liaw ST, Coiera E. An internet intervention to improve asthma management: rationale and protocol of a randomized controlled trial. JMIR Res Protoc 2013; 2:e28. [PMID: 23942523 PMCID: PMC3742402 DOI: 10.2196/resprot.2695] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Many studies have shown the effectiveness of self-management for patients with asthma. In particular, possession and use of a written asthma action plan provided by a doctor has shown to significantly improve patients' asthma control. Yet, uptake of a written asthma action plan and preventative asthma management is low in the community, especially amongst adults. OBJECTIVE A Web-based personally controlled health management system (PCHMS) called Healthy.me will be evaluated in a 2010 CONSORT-compliant 2-group (static websites verse PCHMS) parallel randomized controlled trial (RCT) (allocation ratio 1:1). METHODS The PCHMS integrates an untethered personal health record with consumer care pathways and social forums. After eligibility assessment, a sample of 300 adult patients with moderate persistent asthma will be randomly assigned to one of these arms. After 12 months of using either Healthy.me or information websites (usual care arm), a post-study assessment will be conducted. RESULTS The primary outcome measure is possession of or revision of an asthma action plan during the study. Secondary outcome measures include: (1) adherence to the asthma action plan, (2) rate of planned and unplanned visits to healthcare providers for asthma issues, (3) usage patterns of Healthy.me and attrition rates, (4) asthma control and asthma exacerbation scores, and (5) impact of asthma on life and competing demands, and days lost from work. CONCLUSIONS This RCT will provide insights into whether access to an online PCHMS will improve uptake of a written asthma action plan and preventative asthma actions. TRIAL REGISTRATION Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite at http://www.webcitation.org/6IYBJGRnW).
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Affiliation(s)
- Amaël Arguel
- Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia.
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Richmond CM, Hobson A, Pike E, Kleiss J, Wottowa J, Sterling DA. Breathe Your Best for School Success: evaluation of an initiative to enhance asthma action plans in the school setting. J Urban Health 2011; 88 Suppl 1:68-72. [PMID: 21337053 PMCID: PMC3042070 DOI: 10.1007/s11524-010-9478-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Colleen M Richmond
- Saint Louis University School of Public Health, 3545 Lafayette Avenue, St. Louis, MO 63104, USA.
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