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Asthma Care (asthma + care)
Selected AbstractsTrends in hospital-based management of acute asthma from a teaching hospital in South AsiaINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2005S. F. Hussain Summary The aim of this study is to evaluate the hospital-based management of acute asthma in south Asia and to compare practices over a 10-year period. Adult patients (n = 102) admitted at a teaching hospital with acute asthma were studied. Documentation of precipitating factors, family history and physical signs were inadequate in more than half of patients. Pulse oximetry was documented in 95 (93%) patients, but peak flow monitoring was performed only in 50 (49%) patients. Ten-year trend showed deterioration in history and physical examination skills, under use of peak flow readings, and poor pre-discharge instructions. Some aspects of improved care included frequent use of pulse oximeter, preference of inhaled over systemic bronchodilators and increased use of systemic steroids. Significant deficiencies were identified in hospital-based management of acute asthma. Most aspects of asthma care continued to fall short of asthma guidelines. [source] Psychosocial Care Needs of Children With Recent-Onset AsthmaJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2007Angela M. McNelis PURPOSE.,To examine psychosocial care needs of children with recent-onset asthma. DESIGN/METHODS.,Data were collected over 2 years from 63 children ages 8,14 years. RESULTS.,Children's need for attention to specific aspects of their asthma care remained high over the 2 years, as did their perceived needs for information and support and their concerns and fears. PRACTICE IMPLICATIONS.,Children have many needs, and healthcare professionals may not be providing care that addresses these needs. The Child Report of Psychosocial Care can be used as a quick tool to assess and guide interventions related to specific areas of need. [source] Impoverished Children With Asthma: A Pilot Study of Urban Healthcare AccessJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2004Andrea Wallace ND ISSUES AND PURPOSE Using Andersen's Behavioral Model of Health Care Use, this pilot study was conducted to better understand the experiences of children with asthma as they access an urban healthcare system. DESIGN AND METHODS This descriptive study used a convenience sample of 34 families of pediatric asthma patients who participated in semistructured interviews and closed medical record review. RESULTS Only one patient reported having a written exacerbation management plan. Beliefs regarding medication addiction and side effects were frequently reported as barriers to medication adherence, and children seeking asthma care in primary care settings saw many care providers. PRACTICE IMPLICATIONS Exploring how expanded nursing roles can help address both family and system factors serving as barriers to health care ought to be a key priority for nursing. [source] Impact of quality circles for improvement of asthma care: results of a randomized controlled trialJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2008Antonius Schneider MD Abstract Rationale and aims, Quality circles (QCs) are well established as a means of aiding doctors. New quality improvement strategies include benchmarking activities. The aim of this paper was to evaluate the efficacy of QCs for asthma care working either with general feedback or with an open benchmark. Methods, Twelve QCs, involving 96 general practitioners, were organized in a randomized controlled trial. Six worked with traditional anonymous feedback and six with an open benchmark; both had guided discussion from a trained moderator. Forty-three primary care practices agreed to give out questionnaires to patients to evaluate the efficacy of QCs. Results, A total of 256 patients participated in the survey, of whom 185 (72.3%) responded to the follow-up 1 year later. Use of inhaled steroids at baseline was high (69%) and self-management low (asthma education 27%, individual emergency plan 8%, and peak flow meter at home 21%). Guideline adherence in drug treatment increased (P = 0.19), and asthma steps improved (P = 0.02). Delivery of individual emergency plans increased (P = 0.008), and unscheduled emergency visits decreased (P = 0.064). There was no change in asthma education and peak flow meter usage. High medication guideline adherence was associated with reduced emergency visits (OR 0.24; 95% CI 0.07,0.89). Use of theophylline was associated with hospitalization (OR 7.1; 95% CI 1.5,34.3) and emergency visits (OR 4.9; 95% CI 1.6,14.7). There was no difference between traditional and benchmarking QCs. Conclusions, Quality circles working with individualized feedback are effective at improving asthma care. The trial may have been underpowered to detect specific benchmarking effects. Further research is necessary to evaluate strategies for improving the self-management of asthma patients. [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] Prospective study of the patient-level cost of asthma care in children,PEDIATRIC PULMONOLOGY, Issue 2 2001Wendy J. Ungar PhD Abstract Our objective was to assess the cost of asthma care at the patient level in children from the perspectives of society, the Ontario Ministry of Health, and the patient. In this longitudinal evaluation, health service use data and costs were collected during telephone interviews at 1, 3, and 6 months with parents of 339 Ontario children with asthma. Direct costs were respiratory-related visits to healthcare providers, emergency rooms, hospital admissions, pulmonary function tests, prescription medications, devices, and out-of-pocket expenses. Indirect costs were parents' absences from work/usual activities and travel and waiting time. Hospital admissions accounted for 43%, medications for 31%, and parent productivity losses for 12% of total costs from a societal perspective. Statistically significant predictors of higher total costs were worse symptoms, younger age group, and season of participation. Adjusted annual societal costs per patient in 1995 Canadian dollars varied from $1,122 in children aged 4,14 years to $1,386 in children under 4 years of age. From the Ministry of Health perspective, adjusted annual costs per patient were $663 in children over 4 years and $904 in younger children. Adjusted annual costs from the patient perspective were $132 in children over 4 years and $129 in children under 4 years. The rising incidence of pediatric asthma demands that greater attention be paid to the delivery of optimal care to this segment of the population. Appropriate methods must be used to analyze healthcare costs and the use of services in the midst of widespread healthcare reform. The quality of clinical and health policy decision-making may be enhanced by cost-of-illness estimates that are comprehensive, precise, and expressed from multiple perspectives. Pediatr Pulmonol. 2001; 32:101,108. © 2001 Wiley-Liss, Inc. [source] Asthma management in rural New South Wales: Perceptions of health care professionals and people with asthmaAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2009Biljana Cvetkovski Abstract Objective:,To investigate the perceptions and attitudes towards asthma management of general practitioners, pharmacists and people with asthma in a rural area. Design:,Qualitative semistructured interviews. Setting:,Small rural centre in New South Wales. Participants:,General practitioners, pharmacists and people with asthma in a rural area. Results:,General practitioners perceived that the patient provided a barrier to the implementation of optimal asthma services. They were aware that other health care professionals had a role in asthma management but were not aware of the details, particularly in relation to that of the pharmacist and would like to improve communication methods. Pharmacists also perceived the patient to be a barrier to the delivery of optimal asthma management services and would like to improve communication with the general practitioner. The impact of the rural environment for the health care professionals included workforce shortages, availability of support services and access to continuing education. People with asthma were satisfied with their asthma management and the service provided by the health care professionals and described the involvement of family members and ambulance officers in their overall asthma management. The rural environment was an issue with regards to distance to the hospital during an emergency. Conclusions:,General practitioners and pharmacists confirmed their existing roles in asthma management while expressing a desire to improve communication between the two professions to help overcome barriers and optimise the asthma service delivered to the patient. The patient described minimal barriers to optimising asthma management, which might suggest that they might not have great expectations of asthma care. [source] Inappropriate Use of Antibiotics for Acute Asthma in United States Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 8 2008Stefan G. Vanderweil BA Abstract Objectives:, The aim was to examine the use of antibiotics to treat asthma patients in U.S. emergency departments (EDs). The authors sought to investigate inappropriate antibiotic prescriptions by identifying the frequency and predictors of antibiotics prescribed for asthma exacerbations using data from two sources, the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Emergency Department Safety Study (NEDSS). Methods:, The authors used data from NHAMCS and NEDSS to identify the proportion of ED visits for asthma exacerbations that resulted in the prescription of an antibiotic. NHAMCS provided national data from 1993 through 2004, while NEDSS provided data from 63 primarily academic EDs from 2003 through 2006. Univariate analysis and multivariate logistic regression modeling were used to identify variables associated with antibiotic administration. Results:, Analysis of NHAMCS data revealed that 22% (95% confidence interval [CI] = 20% to 24%) of acute asthma visits resulted in an antibiotic prescription from 1993 through 2004, with no significant change in prescribing frequency over the 12-year period. NEDSS data from 2003 through 2006 showed that 18% (95% CI = 17% to 19%) of acute asthma cases in academic EDs received an antibiotic. Multivariate modeling of NHAMCS data revealed that African American patients (odds ratio [OR] = 0.8; 95% CI = 0.6 to 0.97) and patients in urban EDs (OR = 0.5; 95% CI = 0.4 to 0.7) were less likely to receive antibiotics for asthma exacerbations than white patients and patients in nonurban EDs, respectively. NHAMCS analysis also found that patients in the South were more likely to receive antibiotics than those in the Northeast (OR = 1.4; 95% CI = 1.1 to 1.9). A NEDSS multivariate model found a similar difference, with African Americans (OR = 0.6; 95% CI = 0.4 to 0.8) and Hispanics (OR = 0.6; 95% CI = 0.4 to 0.8) being less likely than whites to receive an antibiotic. Conclusions:, ED treatment of acute asthma with unnecessary antibiotics is likely to contribute to bacterial antibiotic resistance. Interventions are needed to reduce inappropriate antibiotic prescriptions and to address disparities in asthma care. [source] A randomised controlled trial of clinics in secondary schools for adolescents with asthmaCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2004Cliona Ni Bhrolchain Aim To test the hypothesis that delivery of a programme of asthma care in nurse-led clinics in school would improve access to care and health outcomes compared with care in general practice. Methods Pupils at four secondary schools in Bristol, North Somerset and South Gloucestershire, UK, were included in the randomized controlled trial. Another two schools were included to control for any cross-contamination between school clinic attenders and general practice attenders in the trial schools. Pupils in trial schools were randomly assigned to receive an invitation for an asthma review at school or in general practice. Schools were stratified for deprivation and covered rural, urban and suburban populations. Pupils with asthma were identified using a screening questionnaire and then cross-referenced with practice prescribing records. Four school nurses with additional specialist asthma training ran the school clinics weekly. Consultations concentrated on the needs and interests of adolescents and followed national guidelines for treatment changes. Reviews were arranged at 1 and 6 months, with an additional 3-month review if needed. The pupil's GP was kept informed. General practice care was according to the practice's usual treatment protocols. Primary outcomes were the proportion of pupils who had had an asthma review in 6 months, health-related quality of life and level of symptoms. Secondary outcomes were pupil knowledge and attitude to asthma, inhaler technique, the proportion taking inhaled steroids daily, school absence due to asthma, PEFR and pupil preference for the setting of care. Sample size was calculated to have an 80% chance of showing an increase from 40% to 60% having a review in 6 months and half a standard deviation improvement on the quality of life measure. Analysis was on an intention to treat basis. Results School clinic pupils were more likely to attend (91% vs. 51%). However, symptom control or quality of life were no better. School clinic pupils knew more about asthma, had a more positive attitude and better inhaler technique. Absence and PEFR showed no difference. 63% who attended school clinics preferred this model but, taking both groups together, just over half would prefer to attend their GP for follow-up. Cost of care (including practice, school clinic, hospital and medication) was £32.10 at school, £19.80 at the trial practices and £18.00 at control practices. Conclusions Previous evaluations of nurse-led asthma clinics in practice have also failed to show improvements in outcomes, though process measures do improve. This may be due to the need for nurses to refer patients to doctors for changes in medication, rather than doing this themselves. Some weaknesses in study design that may have affected outcome, but the essential conclusion is that nurse-led asthma clinics in school are not cost effective. The study does suggest that such clinics can reach a high proportion of adolescents, but for asthma at least this does not result in any measurable improvement in outcome. [source] | ||||||||||