A comprehensive inner-city asthma program reduces hospital and emergency room utilization

Harish, Ziv; Bregante, Audrey C.; Morgan, Craig; Fann, Cathy S.J.; Callaghan, Catherine M.; Witt, Mary Ann; Levinson, Kim A.; Caspe, William B.

doi:10.1016/s1081-1206(10)62689-0

Cited by 50 publications

(24 citation statements)

References 8 publications

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“…A escolha do desenho, controle histórico, mesmo com limitações, impôs-se frente às dificuldades de desenvolver um estudo de avaliação em uma cidade com a complexidade de Belo Horizonte, além de ser apontado por Gordis 14 hospitalização e de atendimentos de urgência como parâ-metros para avaliar tratamentos preventivos na asma 6,[16][17][18][19][20][21][22][23][24] . Por outro lado, essas variáveis são quantificáveis e também fatos marcantes na vida do paciente, reduzindo o viés de memória 25,26 .…”

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Impact of an asthma management program on hospitalizations and emergency department visits

et al. 2011

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Objectives: To assess the frequency of hospitalizations and emergency department visits of children and adolescents before and after the enrolment in an asthma program.Methods: Medical records of 608 asthmatics younger than 15 years were assessed retrospectively. The frequency of hospitalizations and emergency department visits caused by exacerbations were evaluated before and after enrolment in an asthma program. Patients were treated with medications and a wide prophylactic management program based on the Global Initiative for Asthma (GINA). The before asthma program (BAP) period included 12 months before enrollment, whereas the after asthma program (AAP) period ranged from 12 to 56 months after enrollment. Results:In the BAP period, there were 895 hospitalizations and 5,375 emergency department visits, whereas in the AAP period, there were 180 and 713, respectively. This decrease was significant in all statistical analyses (p = 0.000). Conclusions:Compliance with the GINA recommendations led to a significant decrease in the frequency of hospitalizations and emergency department visits in children and adolescents with asthma.J Pediatr (Rio J). 2011;87(5):412-8: Asthma, hospitalisation, emergency medical services, continuing education, primary health care. ResumoObjetivo: Analisar as frequências de hospitalização e de atendimentos em serviços de urgência ocorridas em crianças e adolescentes antes e após o ingresso em programa de asma no Brasil. Métodos:Prontuários de 608 pacientes menores de 15 anos e com asma foram avaliados retrospectivamente. As frequências de hospitalização por asma e de atendimentos em serviços de urgência para episó-dios agudos de broncoespasmo foram avaliadas nos períodos anterior e posterior à admissão no programa que disponibiliza medicamentos, preconiza abordagem integral do paciente e manejo profilático de acordo com a Global Initiative for Asthma (GINA). O período de observação antes do programa (AP) teve a duração de 12 meses enquanto o depois do programa (DP) variou de 12 a 36 meses. Resultados:No período AP, ocorreram 895 hospitalizações e 5.375 atendimentos em serviços de urgência, e no período DP, ocorreram 180 hospitalizações e 713 atendimentos na urgência. O teste t de Student para amostras pareadas e o modelo de regressão para observações dependentes identificaram efeito significativo do programa em relação às variáveis estudadas (p = 0,000). Conclusões:A adoção das recomendações do GINA levou à redução significativa nas frequências de hospitalização e atendimentos na urgência em crianças e adolescentes com asma. J Pediatr (Rio J). 2011;87(5):412-8:Asma, hospitalização, atendimento de emergência, educação continuada, atenção básica à saúde. Impact of an asthma management program on hospitalizations and emergency department visitsImpacto de um programa de manejo da asma sobre as hospitalizações e os atendimentos de urgência IntroduçãoA asma, reconhecido problema de saúde pública, vem apresentando aumento na prevalência nas últimas décadas em algumas partes do mundo, ...

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Impact of an asthma management program on hospitalizations and emergency department visits

et al. 2011

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“…Post-education outcomes that have been identified by researchers include reductions in the numbers of visits to emergency departments, admissions to hospitals and unscheduled visits to physicians, and in costs related to health care. 8,10,26,[44][45][46][47] From 2005 onward, an increasing number of randomized control trials have been performed. [48][49][50][51][52][53][54][55] Some have focused on schools with children as the target learners [50][51][52] or included a multifaceted approach with education as one component.…”

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confidence: 99%

Small-group, interactive education and the effect on asthma control by children and their families

Watson¹,

Gillespie²,

Thomas³

et al. 2009

Canadian Medical Association Journal

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“…Previous interventions aimed at improving asthma self-management among minority children have produced mixed results, with some reporting decreased symptoms 10,11 and emergency department (ED) visits and hospitalizations 12,13 and others reporting minimal intervention effects. 14,15 Feedback of electronically monitored adherence shows promise as a strategy to increase medication adherence in adults with asthma 16 and HIV.…”

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Adherence Feedback to Improve Asthma Outcomes Among Inner-City Children: A Randomized Trial

et al. 2009

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OBJECTIVE We evaluated the longitudinal effects of home-based asthma education combined with medication adherence feedback (adherence monitoring with feedback [AMF]) and asthma education alone (asthma basic care [ABC]) on asthma outcomes, relative to a usual-care (UC) control group. METHODS A total of 250 inner-city children with asthma (mean age: 7 years; 62% male; 98% black) were recruited from a pediatric emergency department (ED). Health-outcome measures included caregiver-frequency of asthma symptoms, ED visits, hospitalizations, and courses of oral corticosteroids at baseline and 6-, 12-, and 18-month assessments. Adherence measures included caregiver-reported adherence to inhaled corticosteroid (ICS) therapy and pharmacy records of ICS refills. Multilevel modeling was used to examine the differential effects of AMF and ABC compared with UC. RESULTS ED visits decreased more rapidly for the AMF group than for the UC group, but no difference was found between the ABC and UC groups. The AMF intervention led to short-term improvements in ICS adherence during the active-intervention phase relative to UC, but this improvement decreased over time. Asthma symptoms and courses of corticosteroids decreased more rapidly for the ABC group than for the UC group. Hospitalization rates did not differ between either intervention group and the UC group. No differences were found between the ABC and AMF groups on any outcome. CONCLUSIONS Asthma education led to improved adherence and decreased morbidity compared with UC. Home-based educational interventions may lead to modest short-term improvements in asthma outcomes among inner-city children. Adherence feedback did not improve outcomes over education alone.

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A comprehensive inner-city asthma program reduces hospital and emergency room utilization

Cited by 50 publications

References 8 publications

Impact of an asthma management program on hospitalizations and emergency department visits

Impact of an asthma management program on hospitalizations and emergency department visits

Small-group, interactive education and the effect on asthma control by children and their families

Adherence Feedback to Improve Asthma Outcomes Among Inner-City Children: A Randomized Trial

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