Asthma action plans are highly variable and do not conform to best visual design practices

Gupta, Samir; Wan, Flora; Ducharme, FM; Chignell, Mark; Lougheed, M. Diane; Straus, Sharon E.

doi:10.1016/j.anai.2012.01.018

Cited by 22 publications

(36 citation statements)

References 28 publications

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“…National and international asthma guidelines recommend the use of written instructions to promote appropriate use of medications, avoidance of environmental triggers, and advice about when to seek additional medical attention [2,3]. However, systematic reviews indicate that the content, format, and benefits of such written instructions (usually called action plans) are highly variable, with relatively low rates of use because most such action plans are designed by teams of medical experts with relatively little input from patients, caregivers, and clinicians [4,5]. …”

Section: Introductionmentioning

confidence: 99%

Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma

Erwin¹,

Martin

Flippin³

et al. 2016

J. Comp. Eff. Res.

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Aim To present the methods and outcomes of stakeholder engagement in the development of interventions for children presenting to the emergency department (ED) for uncontrolled asthma. Methods We engaged stakeholders (caregivers, physicians, nurses, administrators) from six EDs in a three-phase process to: 1) Define design requirements; 2) Prototype and Refine; and 3) Evaluate. Results Interviews among 28 stakeholders yielded themes regarding in-home asthma management practices and ED discharge experiences. Quantitative and qualitative evaluation showed strong preference for the new discharge tool (CHICAGO Action Plan after ED discharge, CAPE) over current tools. Conclusions Engaging end-users in contextual inquiry resulted in CAPE, a new stakeholder-balanced discharge tool, which is being tested in a multi-center comparative effectiveness trial.

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Section: Introductionmentioning

confidence: 99%

Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma

Erwin¹,

Martin

Flippin³

et al. 2016

J. Comp. Eff. Res.

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“…To address this, OCS recommendations could be operationalised by providing criteria for patients to contact their provider for an OCS prescription, while reserving a standing prescription with a conditional self-management plan only for patients with excellent self-management skills (table 2, footnotes). Also, although we have included the option to add OCS after failed initial ICS intensification as part of the yellow zone, some AAPs have operationalised this through an extra “orange zone” and others by including OCS in the “red zone” [22, 23]. This recommendation should thus be operationalised in accordance with the particular AAP format that the clinician is using.…”

Section: Resultsmentioning

confidence: 99%

“…It should also be noted that exact symptom- and peak expiratory flow-based criteria, as well as the timing for initiating an increase in controller medications (“activating the yellow zone”) during acute loss of asthma control were not specifically detailed in each guideline (table 1) and have been shown to be somewhat variable across existing AAPs [23, 28]. However, based on RCTs demonstrating the efficacy of a four- to five-fold increase in ICS dose [29, 30], we recommend that patients initiate yellow-zone therapy within 24–48 h of loss of control.…”

Section: Resultsmentioning

confidence: 99%

“…Despite this, guidelines did not specify how dose intensifications should be operationalised. A lack of any clear published guidance in this area probably also explains the large variability in yellow zone instructions across existing AAPs [23]. Given that both knowledge of available medication doses and formulations and time are major barriers to AAP usage in busy primary care environments, this uncertainty may also contribute to poor uptake [12, 13].…”

Section: Discussionmentioning

confidence: 99%

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An evidence-based, point-of-care tool to guide completion of asthma action plans in practice

et al. 2017

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Asthma action plans (AAPs) reduce healthcare utilisation, improve quality of life and are recommended across guidelines. However, fewer than 25% of patients receive an AAP, partly due to prescribers' inability to complete “yellow zone” instructions (how to intensify therapy for acute loss of control). We sought to review best evidence to develop a practical, evidence-based tool to facilitate yellow zone guidance in adults.We reviewed recent asthma guidelines and adult studies addressing acute loss of asthma control (January 2010 to March 2016). We developed evidence-based rules for yellow zone therapy and operational guidelines to maximise adherence and minimise errors.We reviewed three guidelines and 11 manuscripts (2486 abstracts screened). Recommendations were comparable but some areas lacked guidance. For 15/43 asthma regimens, the commonly recommended four- to five-fold yellow zone inhaled corticosteroid dose increase was problematic due to regulatory dose limits. We identified evidence-based alternatives for 8/15 regimens. Operational guidance included increasing to a maximum of four inhalations while maintaining baseline inhaler frequency and device in the yellow zone.We developed a practical implementation tool to facilitate AAP delivery at the point of care, addressing existing gaps and uncertainties. Our tool should be implemented as part of a multifaceted approach to augment AAP usage.

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“…An AAP is an evidence-based tool that provides patients with instructions for preventing exacerbations and modifying treatment in response to acute asthma symptoms, such as cough, shortness of breath or wheezing. AAPs typically take the form of a stoplight-color model, with colors signifying a progression in the severity of symptoms, and detailed text outlining appropriate medication and help-seeking responses at each level [45]. The current format of AAPs often includes dense written instructions, which may be a barrier to utilization for families with low literacy, inadequate understanding of asthma, or negative perceptions towards asthma management.…”

Section: Discussionmentioning

confidence: 99%

Comparing Written Versus Pictorial Asthma Action Plans to Improve Asthma Management and Health Outcomes Among Children and Adolescents: Protocol of a Pilot and Feasibility Randomized Controlled Trial (Preprint)

Hynes¹,

Durkin²,

Williford³

et al. 2018

Preprint

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BackgroundAsthma is an important focal point for health-focused research as ineffective symptom management and control can lead to significant morbidity and mortality. Current treatment guidelines for asthma recommend the use of a written asthma action plan (WAAP) to include individualized instruction for daily care and medication use. However, WAAPs are typically written at a 7 th to 9 th grade reading level, which can be a barrier to patients understanding their treatment, having confidence in using a WAAP, and engaging in asthma education during clinic visits. ObjectiveUtilizing a feasibility and pilot Randomized Controlled Trial (RCT) design, the objective of the Take Action for Asthma Control (TAAC) study is to test a symptom-based, computer-generated pictorial asthma action plan (PAAP) in contrast to a standard WAAP, and assess the feasibility and acceptability of the AAP intervention and study procedures. The study has three primary aims: (1) estimate the effect sizes of PAAPs compared to WAAPs, (2) evaluate feasibility and acceptability from the perspectives of key stakeholders, and (3) establish whether parent and youth literacy levels are associated with treatment outcomes. MethodsThis feasibility and pilot RCT is a block randomized, 2-arm, parallel-group clinical trial, lasting 6-months in duration. At baseline, participants are randomly assigned to receive a PAAP or WAAP, which is generated for them and review with them by their asthma physician. Study procedures take place over four separate time points, including a baseline clinic appointment, 1-month telephone follow-up, and 3-and 6-month clinic-based follow-ups. At each time point date are collected related to the main outcomes of AAP knowledge, AAP satisfaction, asthma control, pulmonary function, and adherence to daily asthma medication. A sample size of up 60 participants (ages 8-17 years) is being recruited. Feasibility and acceptability data are collected via one-to-one qualitative interviews with providers involved in the study, and a sub-group of families that participate in the study. ResultsRecruitment for the current phase of the study began in May 2017. It is anticipated that recruitment will continue through May 2018. Full results will immediately follow follow-up data collection. ConclusionsAn asthma action plan is an individualized, evidence-based strategy for patient education and asthma management. The standard WAAP, however, is dense and may be a barrier for families with lower literacy levels. Due to these concerns, many families are not prescribed a WAAP despite national guidelines encouraging its use. Moreover, pictorial asthma action plans (PAAPs) may be an acceptable and feasible alternative for these families.

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Asthma action plans are highly variable and do not conform to best visual design practices

Cited by 22 publications

References 28 publications

Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma

Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma

An evidence-based, point-of-care tool to guide completion of asthma action plans in practice

Comparing Written Versus Pictorial Asthma Action Plans to Improve Asthma Management and Health Outcomes Among Children and Adolescents: Protocol of a Pilot and Feasibility Randomized Controlled Trial (Preprint)

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