Effects of Asthma Education on Children's Use of Acute Care Services: A Meta-analysis (original) (raw)
Asthma Education and its Impact on Emergency Department Visits by Asthmatic Children
The Medical Journal of Cairo University, 2021
Background: Bronchial asthma is a public health problem in all countries irrespective of their level of development, being generally under-diagnosed and undertreated, and most asthma-related deaths commonly occurs in low-income and lower-middle income countries. Children rely heavily on their parents for asthma management. Therefore, asthma education needs to target the entire family. There is a need for ongoing asthma education, increased sensitivity to complex home management, and family-centered interventions by caregivers of asthmatic children that enhance communication and collaboration between caregivers and providers. Aim of Study: This study is aiming at evaluating the effects of an educational asthma program on the frequent visits to the emergency department by asthmatic children and identifying factors associated with frequent emergency department visits. Patients and Methods: This was one arm Interventional clinical trial study has been conducted at pediatric chest clinic...
Pediatric Allergy, Immunology, and Pulmonology, 2016
We evaluated the impact of a comprehensive pediatric asthma management program (the Children's Asthma Wellness Program, CAWP) on the frequency of emergency department (ED) visits and hospital admissions. The CAWP generally consisted of 4 clinic sessions over a 1-year period, but some patients attended fewer clinic sessions, and some required additional clinic sessions due to incomplete asthma control. Patients were evaluated and treated by pediatric pulmonologists, nurse asthma care coordinator/educator, and social worker. We retrospectively reviewed program results over an 8-year period (2005-2013). We compared ED visits and hospital admissions before and after participation in the CAWP. There were 254 children referred to the CAWP; 172 children were enrolled. Fifty-four children (31%) received >6 sessions due to incomplete asthma control. On average, children requiring additional clinic sessions were older and more likely to be African American, hold Medicaid insurance, and have severe asthma. We obtained a minimum of 1-year preprogram and 1-year postprogram administrative data for 86 children (50%). Using each participating child as his/her own control, we found that taking part in the program decreased the risk of ED visits to 0.26 times the preprogram rate (P < 0.0001) and decreased the risk of hospitalizations to 0.13 times the preprogram rate (P < 0.0001). A 1-year comprehensive asthma care program emphasizing close follow-up and asthma education was effective in reducing healthcare utilization by reducing rates of ED visits and hospitalizations. However, a significant fraction of children required additional clinic visits due to gain complete asthma control.
Randomized controlled trial of asthma education after discharge from an emergency department
Journal of Paediatrics and Child Health, 2004
To test the hypothesis that reinforcement of the advice given at the time of discharge from the emergency department by telephone consultation would improve asthma outcomes. Methods: A randomized controlled trial of the parents of 310 children who had been discharged from the emergency department with asthma was undertaken. The parents were randomized to receive either standard care (155 children) or standard care plus education by telephone (155 children) from a trained asthma educator. Symptoms, parental asthma knowledge, parental quality of life and use of asthma action plans and preventer therapy were collected at baseline and 6 months later. The primary measure was days of wheeze in last 3 months; intermediate measures were regular use of preventer medications, possession and use of written asthma action plan, parental asthma knowledge scores and parental quality of life scores. Results: A total of 266 parents (136 intervention) completed the follow-up questionnaires after 6 months. Both groups showed similar symptoms and process measures at baseline, apart from more regular use of preventer medication in the control children. At follow up, the intervention group children were significantly more likely than controls to possess (87.5% vs 72.3%; P = 0.002) a written asthma action plan. Possession of action plans increased from baseline in the intervention group but tended to decrease in the control group. Use of action plans was greater in the intervention group but decreased from baseline in both groups. Both intervention and control groups showed significant decreases in asthma symptoms. Conclusions: Reinforcement by telephone consultation did not improve the primary outcome of wheeze in the last 3 months. However, it increased the possession and regular use of written asthma action plans in the intervention group.
Impact of an asthma management program on hospitalizations and emergency department visits
Jornal de pediatria
To assess the frequency of hospitalizations and emergency department visits of children and adolescents before and after the enrollment in an asthma program. 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 enrollment 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. 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). Compliance with the GINA recommendations led to a significant decrease...
Annals of Thoracic Medicine, 2015
BACKGROUND: Acute exacerbations of bronchial asthma remain a major cause of frequent Emergency Department (ED) visits by pediatric patients. However, other factors including psychosocial, behavioural and educational, are also reportedly associated with repetitive ED visits. Therefore, it is necessary to determine whether such visits are justifiable. OBJECTIVE: The objective of this cross-sectional study was to identify risk factors associated with visits to ED by asthmatic children. METHODS: Asthmatic children (n = 297) between 1-17 years old were recruited and information collected at the time of visiting an ED facility at two major hospitals. RESULTS: Asthmatic patients visited the ED 3.9 ± 3.2 times-per-year, on average. Inadequately controlled asthma was perceived in 60.3% of patients. The majority of patients (56.4%) reported not receiving education about asthma. Patients reflected misconceptions about the ED department, including the belief that more effective treatments are available (40.9%), or that the ED staff is better qualified (27.8%). About half of patients (48.2%) visited the ED because of the convenience of being open 24 hours, or because they are received immediately (38.4%). Uncontrolled asthma was associated with poor education about asthma and/or medication use. Patients educated about asthma, were less likely to stop corticosteroid therapy when their symptoms get better (OR:0.55; 95% CI:0.3-0.9; P = 0.04). CONCLUSION: This study reports that most patients had poor knowledge about asthma and were using medications improperly, thus suggesting inefficient application of management action plan. Unnecessary and frequent visits to the ED for asthma care was associated with poor education about asthma and medication use. Potential deficiencies of the health system at directing patients to the proper medical facility were uncovered and underline the necessity to improve education about the disease and medication compliance of patients and their parents/guardians.
The Effectiveness of Asthma Education Approaches for Children: Group Versus Individual Education
BJSTR, 2017
Objective: Childhood asthma is a common and potentially life-threatening condition and a leading cause of child admission to acute care and emergency services. The importance of educational methods for children and their parents about appropriate asthma management has been highlighted in many studies, but little is known about the effectiveness of educational methods. This study aims to evaluate the effectiveness of group education intervention on asthma in secondary care settings compared with face-to-face education for children (under 18) and their parents. Specifically, it assesses the number of emergency visits, hospital admissions, school absences, quality of life, mortality and cost to provide best evidence for future clinical research and practice.Data sources: MEDLINE, CINHAL, PsycINFO, EMBASE, Web of Science, and SCOPUS databases. Study selections: 15 RCTs identified and their methodological quality assessed using JBI-MAStRI checklist. Results: 15 of 927 studies included in the final review (with reviewer consensus) indicated a significant reduction in number of emergency visits and hospital admissions among those receiving face-to-face. Two studies highlighted the mean number of school absences; one study measured QoL of asthmatic children and their parents, four calculated the health cost of education and none considered mortality rates. Conclusion: Face-to-face education significantly reduces asthmatic children’s emergency visits and hospital admissions.
Can asthma education improve the treatment of acute asthma exacerbation in young children?
Journal of Paediatrics and Child Health, 2013
Acute exacerbation of asthma requires timely and appropriate treatment. Young children are completely reliant on others in this respect. This paper aims to evaluate the effectiveness of staff asthma education programs in ensuring correct treatment for young children experiencing asthma exacerbations in formal care. A systematic review was undertaken of studies focusing on staff asthma education in relation to pharmacological treatment of acute asthma exacerbation. Three randomised controlled trials and seven uncontrolled pre-and post-test intervention studies were included for review. Asthma education was found to increase staff knowledge and confidence in managing asthma. There was a distinct lack of staff performance testing and studies undertaken in the pre-school setting. Staff asthma education appears effective in increasing asthma knowledge; however, utility of this measure is limited with respect to staff performance in treating acute asthma exacerbation. Further studies evaluating asthma education through performance are needed.