Factors associated to recurrent visits to the emergency department for asthma exacerbations in children: implications for a health education programme

Rodríguez‐Martínez, Carlos E.; Sossa, Monica P.; Castro-Rodriguez, José A.

doi:10.1157/13120391

Cited by 16 publications

(22 citation statements)

References 27 publications

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“…Two hundred and sixty-eight primary caregivers (158 Hispanics and 110 AA) of 3-11 year-old children hospitalized with an asthma exacerbation who met the criteria of high health utilization defined by history of 2 or more ED visits 3,4 in addition to those associated with 1 or more hospitalization 6 in the preceding 12 months were recruited between 4/07-3/ 09. This age range was chosen since young children are more dependent on their primary caregivers for overall healthcare and medication administration.…”

Section: Participantsmentioning

confidence: 99%

“…2 Among these urban children, 15%-25% are high healthcare utilizers who have frequent emergency department (ED) visits 3,4 and repeat hospitalizations. 5,6 However, the factors associated with high utilization among these children have not been well characterized.…”

Section: Introductionmentioning

confidence: 99%

“…In addition to the inherent higher disease severity, 2 lack of knowledge among caregivers about the chronic nature of the disease process 4,7 and suboptimal outpatient management by primary care physicians (PCPs) 8 are potential factors associated with the high healthcare utilization among urban children with asthma. Lack of adherence to National Heart Lung and Blood Institute (NHLBI) guidelines in home management of asthma has also previously been associated with poor asthma control.…”

Section: Introductionmentioning

confidence: 99%

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Caregiver Asthma Knowledge, Aptitude, and Practice in High Healthcare Utilizing Children: Effect of an Educational Intervention

Rastogi

Madhok

Kipperman

2013

Pediatric Allergy, Immunology, and Pulmonology

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Factors underlying high healthcare utilization among Hispanic and African American (AA) children with asthma are not well known. We hypothesized that low parental knowledge and suboptimal practices are associated with high healthcare utlization and sought to elucidate these factors and identify ethnicity-specific differences. We also hypothesized that a targeted educational intervention will decrease emergency department (ED) visits and hospitalizations. A 57-item questionnaire investigating asthma knowledge, aptitude, and practice was administered during a hospitalization to 268 caregivers (158 Hispanic and 110 AA) of high healthcare utilizer children. Responses were compared between ethnicities. Participants were randomized into an education group and a control group to investigate the impact of an in-hospital educational intervention on future ED visits and hospitalizations. More than 80% of caregivers knew that asthma is associated with muscle constriction and mucus production. Overall, 66.7%-86.9% of caregivers found preventive steps including allergen avoidance, regular primary care physician (PCP) follow-up, and medication adherence helpful, but only 45.2% reported adherence to controller medications. Similarly, caregivers found management steps, including albuterol use, avoidance of ineffective medications, and need to contact PCP helpful but 33% Hispanic caregivers contacted their child's PCP at the time of the exacerbation leading the current hospitalization, compared with 17% AA caregivers (P = 0.006). Moreover, 40% and 30% Hispanic and 27% and 18% AA caregivers felt stressed and helpless, respectively, about their child's asthma. Despite high baseline levels of knowledge, there were fewer ED visits in the education group (1.56 -1.94) compared with the control group (2.05 -2.32) (P = 0.02) 2 years after the intervention. Although Hispanic and AA caregivers of children with high healthcare utilization were knowledgeable of asthma pathophysiology, and preventive and management steps, they reported being stressed and helpless and were unable to implement the steps at the time of an exacerbation, seeking care at the ED rather than contacting their PCP. The high health utilizers who underwent a targeted educational intervention had fewer ED visits 2 years following the intervention.

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Section: Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Caregiver Asthma Knowledge, Aptitude, and Practice in High Healthcare Utilizing Children: Effect of an Educational Intervention

Rastogi

Madhok

Kipperman

2013

Pediatric Allergy, Immunology, and Pulmonology

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“…Studies that focus on children with status asthmaticus tend to be small 5 and aimed at improving treatment [11][12][13][14][15][16][17][18][19][20][21][22] or preventing recurrence. [23][24][25] Few address larger-scale epidemiologic questions. 26 For example, we know little about whether changes in care have affected rates of status asthmaticus or need for mechanical ventilation.…”

mentioning

confidence: 99%

Trends in Admissions for Pediatric Status Asthmaticus in New Jersey Over a 15-Year Period

et al. 2010

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“…Second, intermittent use of ICS has been proposed as a potentially useful strategy for reducing the cumulative levels of exposure to corticosteroids, thus minimizing the risk of adverse events . Third, in part due to a lack of appropriate educational interventions, many patients, families, and even physicians still consider asthma to be an episodic disease, and so the disease is managed exclusively based on the symptomatic periods or exacerbations, instead of treating inter‐critical periods . Fourth, besides the well‐known effect of prolonged treatment with ICS, a rapid, topical anti‐inflammatory action of ICS has been reported, by a nongenomic mechanism of action that remains unknown .…”

Section: Introductionmentioning

confidence: 99%

Cost‐utility analysis of daily versus intermittent inhaled corticosteroids in mild‐persistent asthma

Rodríguez‐Martínez

Niño

Castro-Rodriguez

2014

Pediatric Pulmonology

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Summary Introduction Despite the many benefits that have been demonstrated by the continuous administration of inhaled corticosteroids (ICS) in persistent asthma, a new strategy for mild-asthma is emerging, consisting of using intermittent or as-needed ICS treatment in conjunction with short-acting beta2 agonists in response to symptoms. However, no previous studies have reported an economic evaluation comparing these two therapeutic strategies. Methods A Markov-type model was developed in order to estimate costs and health outcomes of a simulated cohort of pediatric patients with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a systematic review of the literature. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable “quality-adjusted life-years” (QALYs). Results For the base-case analysis, the model showed that compared to intermittent ICS, daily therapy with ICS had lower costs (US $437.02 vs. 585.03 and US$704.62 vs. 749.81 average cost per patient over 12 months for school children and preschoolers, respectively), and the greatest gain in QALYs (0.9629 vs. 0.9392 QALYs and 0.9238 vs. 0.9130 QALYS for school children and preschoolers, respectively), resulting in daily therapy being considered dominant. Conclusions The present analysis shows that compared to intermittent therapy, daily therapy with ICS for treating pediatric patients with recurrent wheezing and mild persistent asthma is a dominant strategy (more cost effective), because it showed a greater gain in QALYs with lower total treatment costs. Pediatr Pulmonol.

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Factors associated to recurrent visits to the emergency department for asthma exacerbations in children: implications for a health education programme

Abstract: An educational programme intended to reduce the recurrent ED visits for asthma exacerbations should consider the inclusion of an explanation about the chronic nature of the disease and the importance of long-term therapy.

Cited by 16 publications

References 27 publications

Caregiver Asthma Knowledge, Aptitude, and Practice in High Healthcare Utilizing Children: Effect of an Educational Intervention

Caregiver Asthma Knowledge, Aptitude, and Practice in High Healthcare Utilizing Children: Effect of an Educational Intervention

Trends in Admissions for Pediatric Status Asthmaticus in New Jersey Over a 15-Year Period

Cost‐utility analysis of daily versus intermittent inhaled corticosteroids in mild‐persistent asthma

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