Influence of Caregiver and Provider Communication on Symptom Days and Medication Use for Inner-City Children With Asthma
Arlene ButzJoan KubMichele DonithanNathan T. JamesRichard E. ThompsonMelissa H. BellinMona TsouklerisMary E. Bollinger
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Background. Effective pediatric guideline-based asthma care requires the caregiver to accurately relay the child's symptom frequency, pattern of rescue and controller medication use, and level of asthma control to the child's primary care clinician. Objective. This study evaluated the longitudinal effects of a caregiver-clinician asthma communication education intervention (ACE) relative to an asthma education control group (CON) on symptom days and controller medication use in inner-city children with asthma. Participants and Methods. 231 inner-city children with asthma, recruited from urban pediatric emergency departments (EDs) and community practices, were followed for 12 months. Data included number of symptom days and nights, ED visits, hospitalizations, presence of limited activity, and controller medication use over 12 months. Pharmacy records were used to calculate controller to total asthma medication ratios as a proxy of appropriate controller medication use. Multivariate logistic regression models were used to identify factors associated with number of symptom days and nights over the past 30 days at the 12-month follow-up. Results. Most caregivers rated the communication with their child's clinician as high. Unadjusted and adjusted rates of symptom days and nights did not differ by group at follow-up. ACE children trended towards a higher controller to total medication ratio at 12 months as compared to CON children (mean ratio: ACE: 0.54, SD 0.3; CON, 0.45, SD 0.4; p = .07). Activity limitation due to asthma and persistent asthma severity were the only factors significantly associated with reporting any symptom day within the past 30 days, adjusting for treatment group, number of oral corticosteroid courses and number of clinician visits in the last 6 months, seasonality, insurance type, and controller to total asthma medication ratio covariates. Conclusion. A home-based caregiver asthma communication educational intervention was not associated with decreased symptom days. However, a trend was noted in higher controller to total medication ratios in the intervention group. Inner-city caregivers of children with asthma may require a health systems approach to help convey the child's asthma health information to their clinician.Keywords:
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Recent Japanese asthma guideline was published in 2015 (JGL2015). Variability of asthma symptom and airflow limitation was added to its definition. Updated information of pharma- cotherapy in adult asthma was documented. Long-acting anticholinergics as add-on therapy to inhaled corticosteroids combined with a LABA were incorporated into the step 3 and 4 in adult patients. Clinician should confirm treatment adherence and correct inhaler technique, and take enough time to discuss about treatment at every visit.
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Objectives This study was conducted to describe patients at risk for prolonged time alone in the emergency department (ED) and to determine the relationship between clinical outcomes, specifically 30-day hospitalization, and patient alone time (PAT) in the ED. Methods An observational cohort design was used to evaluate PAT and patient characteristics in the ED. The study was conducted in a tertiary academic ED that has both adult and pediatric ED facilities and of patients placed in an acute care room for treatment between May 1 and July 31, 2016, excluding behavioral health patients. Simple linear regression and t tests were used to evaluate the relationship between patient characteristics and PAT. Logistic regression was used to evaluate the relationship between 30-day hospitalization and PAT. Results Pediatric patients had the shortest total PAT compared with all older age groups (86.4 minutes versus 131 minutes, P < 0.001). Relationships were seen between PAT and patient characteristics, including age, geographic region, and the severity and complexity of the health condition. Controlling for Charlson comorbidity index and other potentially confounding variables, a logistic regression model showed that patients are more likely to be hospitalized within 30 days after their ED visit, with an odds ratio (95% confidence interval) of 1.056 (1.017–1.097) for each additional hour of PAT. Conclusions Patient alone time is not equal among all patient groups. Study results indicate that PAT is significantly associated with 30-day hospitalization. This conclusion indicates that PAT may affect patient outcomes and warrants further investigation.
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The purpose of this study was to improve asthma care and outcome in an inner-city emergency department. Consecutive adult patients (19,802) presenting with the diagnosis of acute asthma exacerbation to an inner-city municipal hospital emergency department, between July 1991 and December 1993, were prospectively evaluated. These patients were compared to a historical control group of 7923 consecutive asthma emergency department patients presenting in the year prior to our intervention. An asthma treatment guideline was implemented through a continuous quality improvement process. Asthma relapse rate and admission rate were obtained before and after the guidelines were instituted. Data after interventions were also prospectively compared to asthma outcomes at all other New York City municipal hospital emergency departments. After intervention, mean monthly asthma relapse rates showed a significant reduction from 12.18% to 7.83% (p < 0.001). A similar decrease was also noted in the monthly asthma admission rate, from 4.85 to 3.90 per 100 emergency department visits (p < 0.05). Asthma treatment guidelines along with continuous quality improvement techniques can significantly improve the outcome of inner-city emergency department asthma patients.
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