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National Asthma Education (national + asthma_education)
Selected AbstractsAsthma Pharmacotherapy Prescribing in the Ambulatory Population of the United States: Evidence of Nonadherence to National Guidelines and Implications for Elderly PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2008Prakash Navaratnam MPH OBJECTIVES: To examine the level of physician adherence to the Expert Panel Report 2 (EPR-2) pharmacotherapy guidelines of the asthma population, specifically in the elderly ambulatory patient population of the United States. DESIGN: Retrospective cross-sectional study using a national survey. SETTING: National Ambulatory Medical Care Survey data of U.S. elderly patients from 1998 through 2004. PARTICIPANTS: The weighted population sample size was 82,020,318 patients. There were 1,540 observations in this study (preweighted sample size) and 96 strata, with 446 population sampling units (PSUs). There were 11,868,340 patients that were elderly, and they accounted for 14.5% of the overall population sampled. MEASUREMENTS: Specific patient demographic variables, physician demographic variables, and information about asthma medications prescribed were extracted from the data set and analyzed. Descriptive statistics for the patient demographic, physician demographic, and asthma pharmacotherapy variables were generated. A series of logistic regression models were created, with the choice of asthma pharmacotherapy agent used as the dependent variable and patient and physician demographic variables as the independent variables. RESULTS: A major finding was that physicians were not adherent to the National Asthma Education and Prevention Program EPR-2 asthma pharmacotherapy guidelines. Another finding was that, although elderly patients (aged ,65) were exposed to more-stable patterns of care, they were less likely to be prescribed controller medications, long-acting bronchodilators (LABAs), combinations of inhaled corticosteroids and LABAs, and short-acting beta agonists than patients aged 35 to 64. CONCLUSION: A more-concerted effort needs to be undertaken to improve physician adherence to the EPR-2 guidelines, especially in prescribing asthma pharmacotherapy to elderly patients. [source] The BreathmobileÔ: A Novel Comprehensive School-Based Mobile Asthma Care Clinic for Urban Underprivileged ChildrenJOURNAL OF SCHOOL HEALTH, Issue 6 2006Otto Liao Many school-based programs have been funded to improve asthma management, especially for these "high-risk" inner-city children with asthma. Here we report the outcomes of the Children's Hospital of Orange County Breathmobile program, which is a school-based asthma program that combines the use of a mobile clinic and a pediatric asthma specialist. Baseline evaluations included a detailed history and physical, skin prick test to common allergens, spirometry measurements, and asthma severity classification based on the current National Asthma Education and Prevention Program guidelines. From April 2002 to September 2005, a total of 1321 children were evaluated for asthma. Analysis of the 1112 (84%) children diagnosed with asthma showed a population mean age of 7.8 years, 81% Latino ethnicity, and 73% with persistent disease. At baseline, only 24% of children with persistent asthma were on daily anti-inflammatory medications, which increased to 78% by the first follow-up visit. In the year prior to entry into the program, 64% had school absenteeism related to asthma (38% >10 days), 45% had emergency room (ER) visits (28% >1), and 19% had hospitalizations (9% >1). There was a significant reduction (p < .001) in the annual rates of ER visits, hospitalizations, and school absenteeism when comparing pre- and postentry into the program. These data suggest that a mobile asthma van clinic at the school site with an asthma specialist could be an effective model in reducing morbidity in the underserved child with asthma. Further studies are necessary to determine whether this model is applicable to other inner-city settings. (J Sch Health. 2006;76(6):313-319) [source] An intervention to change clinician behavior: Conceptual framework for the multicolored simplified asthma guideline reminder (MSAGR)JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 8 2009FNP-C Assistant Professor, Mary C. O'Laughlen PhD Abstract Clinical practice guidelines decrease variation in health care because they standardize the care offered by healthcare providers. Seventeen years after publication, the National Asthma Education and Prevention Program (NAEPP) guidelines are considered the "gold standard" in asthma care, yet they remain underutilized despite three revisions with the latest in July 2007. Multiple factors are presented for lack of adherence to the guidelines. This article discusses the Multicolored, Simplified Asthma Guideline Reminder (MSAGR), an algorithm chart intervention for helping change clinicians' behavior for better adherence to the NAEPP guidelines, and describes the conceptual framework underpinning this intervention as a means of predicting better outcomes for providers and children. [source] Food allergy and asthma morbidity in childrenPEDIATRIC PULMONOLOGY, Issue 6 2007Alyson B. Simpson MD Abstract Background Coexisting food allergy and asthma is a significant problem in the pediatric population. Studies have looked at the association between food sensitization and asthma severity. It is unknown whether specific food allergies are associated with increased asthma morbidity. Objective We studied the independent effect that allergy to egg, milk, fish, and peanut has on the number of hospitalizations and courses of systemic steroids in children with asthma. Methods We performed a medical record review to evaluate the effect food allergy to egg, fish, peanut, and milk has on asthma morbidity. We reviewed the records of 201 children aged 3 months to 14 years with the diagnosis of asthma (ICD-9 codes 493.90, 493.91, and 493.92), of which 88 had coexistent food allergy. All children in the food allergy group had food-specific IgE concentrations greater than the 95% positive predictive value. We compared the rate of hospitalizations and use of systemic steroids between children with asthma and food allergies and those without coexisting food allergy using direct-entry, multiple regression analysis. Patients were adjusted for the severity of their asthma based on symptoms documented at their first visit to the allergist according to the National Asthma Education and Prevention Program guidelines and presence of environmental allergy, eczema, smoke exposure, and gastroesophageal reflux. Results Peanut and milk allergies were both associated with increased number of hospitalizations (P,=,0.009, 0.016), and milk allergy was associated with increased use of systemic steroids (P,=,0.001). Conclusion Peanut and milk allergies were associated with increased hospitalization and steroid use and may serve as early markers for increased asthma morbidity. Pediatr Pulmonol. 2007; 42:489,495. © 2007 Wiley-Liss, Inc. [source] | ||||||||||