Delivering Tailored Asthma Family Education in a Pediatric Emergency Department Setting: A Pilot Study

Abstract

OBJECTIVE. Many children are brought to the pediatric emergency department (ED) with acute asthma symptoms. Emergency asthma care is costly, and many ED visits may be preventable. Families often do not have written asthma action plans and lack asthma self-managment skills. This study tests a tailored self-managment intervention delivered in the ED for families of children with asthma. The primary hypotheses were that the intervention group would have greater confidence to manage asthma 14 days postintervention and more well-asthma visits and fewer urgent care/ED visits at 9 and 12 months.METHODS. This randomized intervention/usual-care study was part of a larger ED asthma surveillance project in 4 urban pediatric ED sites. Asthma educators used a computer-based resource to tailor the intervention messages and provide a customized asthma action plan and educational summary. Children with acute asthma were enrolled during an ED visit, and follow-up telephone interviews were conducted during the next 9 months. The ED clinician classified the child's acute and chronic severity.RESULTS. To date, 464 subjects aged 1 to 18 years have been enrolled. The ED clinicians reported that 46% had intermittent and 54% had persistent chronic severity with 51% having mild acute severity episodes. The confidence level to prevent asthma episodes and keep them from getting worse was significantly higher in the intervention group at 14 days postintervention. More subjects in the intervention group reported well-asthma visits by 9 months. Return ED visits were significantly lower in the intervention group in those with intermittent asthma. Twelve-month follow-up is in process.CONCLUSIONS. The tailored ED self-management intervention demonstrates significant effects on caregiver self-confidence and well-visit follow-up. Additional evaluation is needed to determine what impact this intervention has long-term. A N ESTIMATED 9 million (12.5%) children Ͻ18 years of age in the United States have had asthma diagnosed at some time in their lives. 1 Asthma morbidity and mortality have increased dramatically in the United States in the last 2 decades. The economic burden of asthma is increasing, with hospitalizations accounting for 46% to 50% of costs and emergency department (ED) visits accounting for ϳ8%. 2 Emergency care visits cost 5 times more than primary care visits. 3 Every year, 1 of 3 children with asthma visit an ED because of an asthma-related event. 3 These ED visits and hospitalizations may be preventable through either better chronic asthma control or early recognition of acute symptoms and intervention in the primary care setting.Children with asthma may lack a primary medical provider and may depend on ED services for their care. Routine primary medical care is hampered by a lack of medical insurance and by other barriers such as access to transportation. There are disparities in asthma severity and access to care with respect to ethnicity and socioeconomic status, and minority children and those with low socioeconomic s...

Effectiveness of a multimedia outreach kit for families of wounded veterans

“…In most families, all of these uses occurred. These findings are consistent with other studies showing that engaging electronically delivered interventions can be appealing to families (25).…”

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

“…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. 50,53,54 The results generally have been positive, showing increases in knowledge, fewer symptoms and fewer absences from school.…”

“…[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. 50,53,54 The results generally have been positive, showing increases in knowledge, fewer symptoms and fewer absences from school. Although studies that involved multifaceted programs showed fewer visits to emergency departments, it is difficult to conclude with certainty that such outcomes are attributable solely to the educational component in these studies.…”

“…Although studies that involved multifaceted programs showed fewer visits to emergency departments, it is difficult to conclude with certainty that such outcomes are attributable solely to the educational component in these studies. 53,54 Our program remains unique in that it incorporates the principles of small-group learning for children or for both children and their parents and includes only an educational intervention.…”

54. Providing Adolescent Sexual Health Care in the Pediatric Emergency Department: Views of Health Care Providers

“…18,20,21 While limited data supports the use of health educators in the pediatric ED, this research is novel because there is a paucity of information regarding 1) adolescents as the intervention recipients and 2) interventions focused on pregnancy and STI detection and prevention. 12,24,25 Several areas were identified that should inform future education efforts. First, while many HCPs advocated for protecting adolescent health and safety, their success may be impaired by knowledge deficits surrounding confidentiality and age of consent for sexual intercourse and medically emancipated conditions.…”