Use Of Asthma Action Plans Research Articles

Parental perceptions and knowledge toward Asthma Action Plans

Introduction Personalized Asthma Action Plans (AAPs) are a cornerstone of pediatric asthma management. We aimed to assess parental knowledge and perceptions of the use of AAPs in managing their child’s asthma. Methods In 2023 we conducted a cross-sectional survey to assess knowledge and perceptions of AAPs in parents/caregivers of children aged 0–17 years with asthma who had an AAP and attended respiratory clinics at Sydney Children’s Hospital, Randwick. The questionnaire included parental perceptions on the utility of AAPs, parental asthma management self-efficacy (PAMSE), and an adapted version of the Asthma Action Plan Knowledge Interview tool (AAPKI). Descriptive statistics and regression analyses were used to assess associations between AAPKI, PAMSE and other outcomes. Results Seventy-one parents completed the survey. Mean PAMSE score was 4.2/5 (SD 0.5). Median AAPKI score was 70.2% out of 100% (IQR 20.4%). Most parents (80.0%, n = 56) were satisfied/very satisfied with using AAPs to manage their child’s asthma. Most agreed/strongly agreed that AAPs were helpful in knowing when to seek medical attention for their child’s asthma (81.7%, n = 58), helped their understanding of asthma severity (81.7%, n = 58), and increased their confidence in asthma management (76.0%, n = 54). Over half of parents (55.7%, n = 39) would prefer AAPs digitally and majority (78.6%, n = 55) would like color-coded AAPs. Conclusion High levels of AAP knowledge and self-efficacy scores were demonstrated. Most parents expressed understanding of the benefits of AAPs. Our findings suggest parents of children with asthma prefer AAPs in color and in digital version which may help guide standardization of AAPs across Australia.

Asthma patients' and physicians’ perspectives on the burden and management of asthma: Post-hoc analysis of APPaRENT 1 and 2 to assess predictors of treatment adherence

IntroductionPatient adherence to maintenance medication is critical for improving clinical outcomes in asthma and is a recommended guiding factor for treatment strategy. Previously, the APPaRENT studies assessed patient and physician perspectives on asthma care; here, a post-hoc analysis aimed to identify patient factors associated with good adherence and treatment prescription patterns. MethodsAPPaRENT 1 and 2 were cross-sectional online surveys of 2866 adults with asthma and 1883 physicians across Argentina, Australia, Brazil, Canada, China, France, Italy, Mexico, and the Philippines in 2020–2021. Combined data assessed adherence to maintenance medication, treatment goals, use of asthma action plans, and physician treatment patterns and preferences. Multivariable logistic regression models assessed associations between patient characteristics and both treatment prescription (by physicians) and patient treatment adherence. ResultsPatient and physician assessments of treatment goals and adherence differed, as did reporting of short-acting β2-agonist (SABA) prescriptions alongside maintenance and reliever therapy (MART). Older age and greater patient-reported severity and reliever use were associated with better adherence. Patient-reported prescription of SABA with MART was associated with household smoking, severe or poorly controlled asthma, and living in China or the Philippines. ConclusionsResults revealed an important disconnect between patient and physician treatment goals and treatment adherence, suggesting that strategies for improving patient adherence to maintenance medication are needed, focusing on younger patients with milder disease. High reliever use despite good adherence may indicate poor disease control. Personalised care considering patient characteristics alongside physician training in motivational communication and shared decision-making could improve patient management and outcomes.

Functionality and Quality of Asthma mHealth Apps and Their Consistency With International Guidelines: Structured Search and Evaluation.

Asthma is a chronic respiratory disorder requiring long-term pharmacotherapy and judicious patient self-management. Few studies have systematically evaluated asthma mobile health (mHealth) apps for quality and functionality; however, none have systematically assessed these apps for their content alignment with international best practice guidelines. This review aims to conduct a systematic search and evaluation of current mHealth apps in the Australian marketplace for their functionality, quality, and consistency with best practice guidelines. The most recent Global Initiative for Asthma (GINA) guidelines were reviewed to identify key recommendations that could be feasibly incorporated into an mHealth app. We developed a checklist based on these recommendations and a modified version of a previously developed framework. App stores were reviewed to identify potential mHealth apps based on predefined criteria. Evaluation of suitable apps included the assessment of technical information, an app quality assessment using the validated Mobile App Rating Scale (MARS) framework, and an app functionality assessment using the Intercontinental Medical Statistics Institute for Health Informatics (IMS) Functionality Scoring System. Finally, the mHealth apps were assessed for their content alignment with the GINA guidelines using the checklist we developed. Of the 422 apps initially identified, 53 were suitable for further analysis based on inclusion and exclusion criteria. The mean number of behavioral change techniques for a single app was 3.26 (SD 2.27). The mean MARS score for all the reviewed apps was 3.05 (SD 0.54). Of 53 apps, 27 (51%) achieved a total MARS score of ≥3. On average, the reviewed apps achieved 5.1 (SD 2.79) functionalities on the 11-point IMS functionality scale. The median number of functionalities identified was 5 (IQR 2-7). Overall, 10 (22%) of the 45 apps with reviewer consensus in this domain provided general knowledge regarding asthma. Of 53 apps, skill training in peak flow meters, inhaler devices, recognizing or responding to exacerbations, and nonpharmacological asthma management were identified in 8 (17%), 12 (25%), 11 (28%), and 14 (31%) apps, respectively; 19 (37%) apps could track or record "asthma symptoms," which was the most commonly recorded metric. The most frequently identified prompt was for taking preventive medications, available in 9 (20%) apps. Five (10%) apps provided an area for patients to store or enter their asthma action plan. This study used a unique checklist developed based on the GINA guidelines to evaluate the content alignment of asthma apps. Good-quality asthma apps aligned with international best practice asthma guidelines are lacking. Future app development should target the currently lacking key features identified in this study, including the use of asthma action plans and the deployment of behavioral change techniques to engage and re-engage with users. This study has implications for clinicians navigating the ever-expanding mHealth app market for chronic diseases. PROSPERO CRD42021269894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269894. RR2-10.2196/33103.

A Primary Care-Based Quality Improvement Project to Reduce Asthma Emergency Department Visits.

Asthma exacerbation is a common and often preventable cause of Emergency Department (ED) utilization. Children eligible for Medicaid are at increased risk of poor asthma control and subsequent ED visits. In 2010, we implemented a multicomponent longitudinal quality improvement project to improve pediatric asthma care for our primary care population, which was 90% Medicaid-eligible. Our goal was to reduce asthma-related ED visits by patients ages 2 to 18 years by 3% annually. The setting was a multisite large urban high-risk primary care network affiliated with a children's hospital. We implemented 5 sequential interventions within our network of pediatric primary care centers to increase: use of asthma action plans by clinicians, primary care-based Asthma Specialty Clinic visits (extended asthma visits in the main primary care site), use of a standard asthma note at all visits, documentation of the Asthma Control Test, and step-up therapy for children with poorly controlled asthma. At baseline in 2010, there were 21.7 asthma-related ED visits per 1000 patients per year. By 2019, asthma-related ED visits decreased to 14.5 per 1000 patients per year, a 33% decrease, with 2 center line shifts over time. We achieved and sustained our goal metrics for 4 of 5 key interventions. We reduced ED utilization for asthma in a large, high-risk pediatric population. The interventions implemented and used over time in this project demonstrate that sustainable outcomes can be achieved in a large network of primary care clinics.

Asthma control and care among six public health clinic attenders in Malaysia: A cross-sectional study.

Asthma is common in Malaysia but neglected. Achieving optimal asthma control and care is a challenge in the primary care setting. In this study, we aimed to identify the risk factors for poor asthma control and pattern of care among adults and children (5-17 years old) with asthma attending six public health clinics in Klang District, Malaysia. We conducted a cross-sectional study collecting patients' sociodemographic characteristics, asthma control, trigger factors, healthcare use, asthma treatment, and monitoring and use of asthma action plan. Descriptive statistics and stepwise logistic regression were used in data analysis. A total of 1280 patients were recruited; 85.3% adults and 14.7% children aged 5-17 years old. Only 34.1% of adults had well-controlled asthma, 36.5% had partly controlled asthma, and 29.4% had uncontrolled asthma. In children, 54.3% had well-controlled asthma, 31.9% had partly controlled, and 13.8% had uncontrolled asthma. More than half had experienced one or more exacerbations in the last 1 year, with a mean of six exacerbations in adults and three in children. Main triggers for poor control in adults were haze (odds ratio [OR] 1.51; 95% confidence interval [CI] 1.13-2.01); cold food (OR 1.54; 95% CI 1.15-2.07), extreme emotion (OR 1.90; 95% CI 1.26-2.89); air-conditioning (OR 1.63; 95% CI 1.20-2.22); and physical activity (OR 2.85; 95% CI 2.13-3.82). In children, hot weather (OR 3.14; 95% CI 1.22-8.11), and allergic rhinitis (OR 2.57; 95% CI 1.13-5.82) contributed to poor control. The majority (81.7% of adults and 64.4% of children) were prescribed controller medications, but only 42.4% and 29.8% of the respective groups were compliant with the treatment. The importance of an asthma action plan was reported less emphasized in asthma education. Asthma control remains suboptimal. Several triggers, compliance to controller medications, and asthma action plan use require attention during asthma reviews for better asthma outcomes.

Factors Influencing Use of Personalized Asthma Action Plans among Adult Patients Aged 18-65 in Nyamira County Kenya

Introduction: Globally the World Health Organization (WHO) estimates that up to 334 million people suffer from asthma. In Kenya it is estimated that about 10% of the Kenyan population, or 4 million people, have asthma.
 Aim: The objective of this study was to assess factors influencing the use of personalized asthma action plans among patients aged 18-65 in Nyamira County.
 Methodology: Cross-sectional study design was employed in this research. Participants were selected using systematic sampling. Significant differences in categorical variables were found using the Chi-square and Fisher's Exact Test. The threshold for statistical significance was set at p<0.05.
 Results: The study sample size was 220 asthma patients. Findings showed that majority did not use PAAPs with a response of 168(76.4%) respondents while those who used were 52(23.6%). Knowledge on PAAPs was low at 160(72.7%) against, 60(27.3%) who were knowledgeable. There was poor attitude and practices on use of PAAPs. Statistically there were significant association between the various patients’ factors influencing use of asthma action plans among adult asthmatic patients with a p = 0. 021. Among the health care givers, on knowledge of PAAPs 3 had knowledge while 3 did not. Among those who had knowledge the practice on use was low in which majority indicated that they don’t discuss and prescribe PAAPs with a response of 5 while 1 do. Statistically there were significant association on the health care workers’ factors influencing use of PAAPs at p = 0.03. Lack of training was a key institutional factor hindering use in which 3 (60.0%) had received training in the last 6 months while 2(40.0%) had not received. Statistically there were significant association on the institutional factors influencing use of PAAPs at p = 0.004.
 Conclusion: From the respondent’s majority of the patients were found not to be using the personalized asthma action plan cards. Lack of knowledge was a leading factor among the patient’s respondents. There was also a poor attitude reported in the patients’ respondents in which majority felt that they were for very sick patients. Among the health care givers; only one out of the six had this template/card in their office. Although half of the health care givers had general knowledge but it was not demonstrated in the use of PAAPs hence showing a gap in some specific skills needed. More workload and lack of these templates in the clinics were the major institutional factors hindering use of these tools.

Knowledge, Attitude and Practices on the Use of Asthma Action Plans among Adult Asthmatic Patients Aged 18-65 in Nyamira, Kenya

Introduction: Globally the World Health Organization (WHO) estimates that up to 334 million people suffer from asthma. In Kenya it is estimated that about 10% of the Kenyan population, or 4 million people, have asthma.
 Aim: The objective of this study was to assess knowledge, attitude and practices of patients 18-65 on the use of personized asthma action plans in Nyamira County.
 Methodology: Cross-sectional study design was employed in this research. Participants were selected using systematic sampling. Significant differences in categorical variables were found using the Chi-square and Fisher's Exact Test. The threshold for statistical significance was set at p<0.05.
 Results: The study sample size was 220 asthma patients. The majority of responders 72.7% were unaware of PAAPs. Concerning attitude, most of participants had a negative attitude about the use of PAAPs, believing that they should only be used by the extremely ill 63.6%. Poor practices were seen among the patients who had access to these tools, with 39.0% checking them at home and 61.0% never checking them at all. Statistically there were significant association between the various patients’ factors influencing use of asthma action plans among adult asthmatic patients with a p = 0. 021.
 Conclusion: The majority of the patients 76.4% who participated in this research did not use the personalized asthma action plan cards. Additionally, the majority of participants reported poor practices on PAAPs, low levels of awareness, and negative attitudes. To combat the low-level knowledge, negative attitude, and poor practices among asthma patients, the ministry of health should raise awareness about the use of PAAPs.

INCREASING PATIENT CONFIDENCE MANAGING ASTHMA USING ASTHMA ACTION PLANS

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Asthma is a common illness affecting 8% of the US population and costing $81.9 billion per year. Due to its chronic and variable nature, asthmatics need frequent medication adjustments, making management challenging for both physicians and patients. Patients can control their asthma with an asthma action plan (AAP), which has directions for daily assessment, medications, and steps to detect and treat exacerbations. Self-management using AAPs is associated with a reduction in hospital admissions and ED visits by 40% and 20%, respectively. Despite evidence that AAPs are efficacious, the exact reason for their success is not known. We hypothesized that AAPs increase patient confidence managing asthma and that this is a reason for AAPs success. Our study explored whether AAP use increases confidence in self-management and asthma control. METHODS: Patients with a physician diagnosis of asthma were recruited. An eight-question Likert Scale survey developed prior gauged confidence about asthma management. At the initial visit, each patient completed the survey, received a personalized AAP, and was taught to use a peak flow meter. The same survey was given at a follow-up scheduled at the provider’s discretion. Asthma control was assessed pre and post-AAP use with the Asthma Control Test (ACT), a validated measure of asthma control. An ACT score of ≥ 19 indicates good control. All data was collected using REDCap. Results were calculated using the student t-test. RESULTS: We recruited 71 patients, and 17 were excluded for lack of follow-up. Post-AAP use, confidence using a peak flow meter increased by 45%, with 93% (50/54) rating confidence at ≥ 3 (4 being ‘strongly agree I am confident’). Fifteen percent more patients felt confident managing exacerbations, with 95% (51/54) rating confidence at ≥ 3. A 15% increase was seen in knowing asthma triggers, with 89% (48/54) rating confidence at ≥ 3. Confidence understanding medications was not impacted by AAPs, with 94% (51/54) of patients rating confidence at ≥ 3 pre and post-AAP use. Mean pre and post-AAP survey scores were 23.28 and 25.89, respectively. AAP use was associated with significantly higher mean survey scores (25.89±4.16, p =.0001). ACT data was available for 87% (47/54) of patients and 68% (32/47) scored a ≥ 19 on the follow-up ACT. Mean pre and post-AAP scores were 18.49 and 20.11, respectively. AAP use was associated with significantly higher mean ACT scores (20.11±3.35, p =.0043). CONCLUSIONS: This is the first study that shows AAP use increases patient confidence in asthma management. All but one survey question gauged at measuring increased confidence improved post-AAP use. Understanding of asthma medications likely did not see improved confidence due to a lack of discussion about this during AAP education at the initial visit. AAP use resulted in an improved mean ACT score. It is unclear if this is due to AAP use or changes made in medications. Limitations include the variable time interval for follow-up and the lack of ongoing assessment to account for the variable nature of asthma control. CLINICAL IMPLICATIONS: With an increasing reliance on telemedicine during the COVID-19 pandemic, the importance of self-management has been brought to the forefront. AAPs are a simple and effective tool that help physicians hand control over care to their patients. The routine use of AAPs can revolutionize how providers approach asthma management and reduce asthma morbidity. DISCLOSURES: No relevant relationships by Pankhuri Jha, source=Web Response No relevant relationships by Jessica Most, source=Web Response

Assessment of Variation in Care Following Hospital Discharge for Children with Acute Asthma.

PurposeTo evaluate potential variation in care management pathways following hospital discharge for children with asthma in New South Wales, Australia.MethodsA cross-sectional web-based survey was conducted in emergency departments (EDs) and paediatric units of public hospitals with more than five paediatric beds within New South Wales, Australia, between July 2018 and March 2019. Nursing and medical staff in EDs and paediatric units who had cared for children aged under 18 years with asthma in the preceding 12 months were invited to participate in this study. Outcome measures included use of clinical practice guidelines and asthma action plan (AAP); advice on post-hospitalization follow-up; provision of asthma education for parents/carers; availability of community-based asthma services; communication with schools/childcare services.ResultsA total of 502 participants (236 nursing and 266 medical staff, response rate=22%) from 37 hospitals were included. Overall, the use of AAP was not universal (median=90%; IQR=81–96%) with significant difference across local health districts (LHDs) (88.6%, 95% CI=85.4–91.3) and between EDs and paediatric wards (p=9.4×10−9); and a range of asthma clinical practice guidelines were used. Post-hospitalization follow-up within 2–3 days was recommended by 70% of the respondents, but only 8% reported that hospitals had a system in place to ensure follow-up compliance. Formal asthma education sessions (27% respondents) were seldom provided to parents/carers during hospital stays, especially in EDs (14% respondents). Less than 50% of the respondents were aware of any asthma community services for children and only 4% reported that schools/childcare services were notified about the child’s hospital admission for an asthma flare up.ConclusionThere are marked variations in the post-hospitalization asthma care and community management for children in NSW. An integrated standardized model of care may improve health outcomes in children with asthma.

Formative Evaluation for Implementation of a Low Literacy Pictorial Asthma Action Plan Delivered via Telehealth Improves Asthma Control.

Consistently uncontrolled asthma in children is an increasing concern in the United States. The use of asthma action plans with asthma education is inconsistent and may be improved with adaptations for low literacy. The objective of this study was formative evaluation for implementation of the New Mexico Pictorial Asthma Action Plan (NM PicAAP). Quality improvement processes guided NM PicAAP face validation and telehealth direct patient care implementation. The asthma control test was selected to measure asthma control. NM PicAAP was revised for face validity, and training curriculum on its use and telehealth implementation processes were developed. Seven youth received NM PicAAP via telehealth direct care, which increased overall asthma control scores over 1 month. NM PicAAP may be useful and effective for improving asthma care in children via telehealth. Additional testing is needed to assess applicability.

Use of National Asthma Guidelines by Allergists and Pulmonologists: A National Survey

Little is known about specialist-specific variations in guideline agreement and adoption. To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program's Third Expert Panel Report. Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n= 134) and pulmonologists (n= 99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and "almost always" adhering to recommendations (ie, ≥75% of the time). Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups "almost always" assessed asthma control (66.2%, standard error [SE] 4.3), assessed school/work asthma triggers (71.3%, SE, 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of the inhaler technique, use of asthma action/treatment plans, and spirometry were lower (39.7%, SE 4.0; 30.6%, SE 3.6; 44.7%, SE 4.1, respectively). Compared with pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P= .06), asked about nighttime awakening (91.9% vs 76.5%, P= .03) and emergency department visits (92.2% vs 76.5%, P= .03), assessed home triggers (70.5% vs 52.6%, P= .06), and performed allergy testing (61.8% vs 21.3%, P < .001). In multivariate analyses, practice-specific characteristics explained differences except for allergy testing. Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake.

Electronic Health Record (EHR) Quality Tools Improved and Sustained Use of Asthma Action Plans for 3 years in a Primary Care Pediatric System

Background: 6 million US children have asthma resulting in 800,000 asthma-emergency room visits per year. Asthma Action Plans are recommended for patients to improve asthma control but are not consistently utilized in busy pediatric primary care clinics. Specific Aim: The specific aim of this project was to develop EHR quality tools to increase the use of written Asthma Action Plans (wAAP) to pediatric patients to improve asthma control and reduce asthma-related ER visits. Design/Methods: Our primary care pediatric system includes 8 clinics with 37 pediatricians serving 46,000 patients approximately 10% with asthma. Plan-Do-Check-Act quality improvement methods including fishbone diagrams and A3s were used to develop EHR pediatric asthma registries and team-based tools including well-child visit and …

Electronic Health Record (EHR) Quality Tools Improved and Sustained Use of Asthma Action Plans for 3 years in a Primary Care Pediatric System

Electronic Health Record (EHR) Quality Tools Improved and Sustained Use of Asthma Action Plans for 3 years in a Primary Care Pediatric System

Asthma self-management in children: a best practice implementation project.

Asthma is one of the most common diseases in children. A self-management program can effectively improve the outcomes for children with asthma and reduce the burden on healthcare services. The aim of this project was to integrate the best evidence on asthma self-management with practice in a children's respiratory clinic and to improve compliance with best practice. Seven audit criteria were developed for the pre- and post-audit based on the best available evidence. The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tools were used in this project. The baseline audit showed a gap between clinical practice and the best evidence. The only criterion that achieved high compliance was provision of inhaler guidance (100%). After implementation, there were substantial improvements in compliance for many criteria. Training of clinicians increased from 13% at baseline to 67% at follow-up. Education of parents improved, with specific education about asthma triggers increasing from 55% to 100%, education about warning signs from 30% to 85% and education about effective asthma treatment options from 40% to 85%. Use of written asthma action plans increased from 0% to 25%. Strategies developed in this project were effective at providing necessary information for parents and improved the compliance with evidence. Further implementation strategies and audits are still needed to improve the use of asthma action plans and ensure they are reviewed periodically.

Asthma Education Delivered in the Emergency Department: Does it Encourage Asthma Self-management?

Background: The rates of optimal asthma control and compliance to treatment in Israel are reportedly low. We postulated that adults attending our emergency department (ED) with asthma exacerbation were not using self-management strategies optimally. Objectives: This pilot study aims to: (a) verify the above hypothesis and, if applicable, (b) determine whether an asthma education intervention (AEI) administered in the ED would encourage post-discharge use of a written asthma action plan (AAP). Methods: Thirty-eight adults (>18 yr.) visiting the ED with asthma exacerbation received a 30-min AEI including a written AAP. Prior asthma education was assessed by questionnaire. Follow-up, carried out by phone ≥ 12 months after discharge, assessed AAP use, asthma control (GINA), and exacerbations in the past year. Results: At baseline, participants denied previous education on asthma selfmanagement and AAP use. Of 27 patients available for follow-up, only 5 (18.5%) were using the AAP, assisted by their care-provider. Eighteen subjects (66.7%) presented uncontrolled asthma while, as a whole, the group reported significantly more exacerbation episodes than at enrolment (mean (SD)=5.1 (6.5) vs. 2.7 (3.0) (p=0.0498)). Finally, compared with AAP non-users (n=22) AAP users (n=5) tended to have better asthma control (60% vs. 18%) and fewer episodes of exacerbations (mean (SD)=2.8 (2.2) vs 5.9 (6.9)) but the differences did not reach significance. Conclusion: Delivery to adults of a short AEI in the ED was of limited efficiency in post-discharge boosting of patient/doctor partnership, resulting in sub-optimal AAP use. Feasibility of the AEI in a crowded ED, however, justifies further research on AEI delivery coupled with alternative follow-up strategies targeting patient and doctor perception of AAPs.

San Francisco childcare centers' preparedness in the prevention and management of asthma among preschool-aged children

Introduction: Asthma is a common health condition for children in childcare. National recommendations for asthma in childcare exist. However, no studies have investigated the extent to which childcare centers adhere to these recommendations. We aimed to assess childcare center adherence to National Asthma Education and Prevention Program (NAEPP) recommendations for asthma care and preparedness and to identify characteristics associated with increased adherence to national asthma recommendations. Methods: We developed a standardized instrument. Each childcare center received a score of 0 through 7 based on number of recommendations met. We conducted t-tests, chi square tests and linear regression to identify childcare center factors associated with increased asthma preparedness. Results: 36 out of 40 eligible childcare centers (90%) participated. These sites served 1570 children primarily between the ages of 2 to 5 years. On average, centers met 3.8 out of 7 (SD = 1.3) recommendations. Staff familiarity caring for children with asthma (p < 0.001) and the center's asthma prevalence (p = 0.01) was positively associated with the center's asthma preparedness. The 3 areas most in need of improvement related to asthma medications, asthma action plans and asthma policies. None of the managers reported being familiar with the NAEPP recommendations. Discussion: There is room for improvement in the asthma care and preparedness of childcare centers. The 3 areas in which centers performed poorly (appropriate asthma medication management, use of asthma action plans, and presence of appropriate asthma policies) suggest that closer collaboration between clinicians and childcare centers may be a key to improving asthma management for young children.

Asthma education: different viewpoints elicited by qualitative and quantitative methods

Objective: This project began as a qualitative examination of how asthma education provided by health professionals could be improved. Unexpected qualitative findings regarding the use of Asthma Action Plans and the importance of insurance reimbursement for asthma education prompted further quantitative examination.Methods: Qualitative individual interviews were conducted with primary care physicians in private practice who routinely provide initial diagnoses of asthma and focus groups were conducted with other clinicians in private primary care practices who routinely provide asthma education. Using the DocStyles quantitative tool two questions regarding Asthma Action Plans and insurance reimbursement were asked of a representative sample of physicians and other clinicians.Results: The utility of Asthma Action Plans was questioned in the 2012 qualitative study. Qualitative findings also raised questions regarding whether reimbursement is the barrier to asthma education for patients performed by medical professionals it is thought to be. 2013 quantitative findings show that the majority of clinicians see Asthma Action Plans as useful. The question of whether reimbursement is a barrier to providing asthma education to patients was not resolved by the quantitative data.Conclusions: The majority of clinicians see Asthma Action Plans as a useful tool for patient education. Clinicians had less clear opinions on whether the lack of defined reimbursement codes acted as a barrier to asthma education. The study also provided useful audience data for design of new asthma educational tools developed by CDC.

Effectiveness of an asthma quality improvement program designed for maintenance of certification.

Pediatricians are required to perform quality improvement for board recertification. We developed an asthma project within the Pediatric Physicians' Organization at Children's, an independent practice association affiliated with Boston Children's Hospital, designed to meet recertification requirements and improve asthma care. The program was based on the learning collaborative model. We developed practice-based registries of children 5 to 17 years of age with persistent asthma and helped physicians improve processes of asthma care through education, data feedback, and sharing of best practices. Fifty-six physicians participated in 3 cohorts; 594 patients were included in the project. In all cohorts, improvements occurred in the use of asthma action plans (62.4%-76.8% cohort 1, 50.6%-88.4% cohort 2, 53.0%-79.6% cohort 3) and Asthma Control Tests (4.6%-55.2% cohort 1, 9.0%-67.8% cohort 2, 15.2%-61.4% cohort 3). Less consistent improvements were observed in seasonal influenza vaccines, controller medications, and asthma follow-up visits. The proportion of patients experiencing ≥1 asthma exacerbation within the year declined in all 3 cohorts (37.8%-19.9%, P = .0002 cohort 1; 27.8%-20.7%, P = .1 cohort 2; 36.6%-26.9%, P = .1 cohort 3). For each cohort, asthma exacerbations declined to a greater extent than those of a comparison group. This asthma quality improvement project designed for maintenance of certification improved processes of care among patients with persistent asthma. The learning collaborative approach may be a useful model for other board-recertification quality improvement projects but requires a substantial investment of organizational time and staff.

A Randomized trial of an Asthma Internet Self-management Intervention (RAISIN): study protocol for a randomized controlled trial.

BackgroundThe financial costs associated with asthma care continue to increase while care remains suboptimal. Promoting optimal self-management, including the use of asthma action plans, along with regular health professional review has been shown to be an effective strategy and is recommended in asthma guidelines internationally. Despite evidence of benefit, guided self-management remains underused, however the potential for online resources to promote self-management behaviors is gaining increasing recognition. The aim of this paper is to describe the protocol for a pilot evaluation of a website ‘Living well with asthma’ which has been developed with the aim of promoting self-management behaviors shown to improve outcomes.Methods/DesignThe study is a parallel randomized controlled trial, where adults with asthma are randomly assigned to either access to the website for 12 weeks, or usual asthma care for 12 weeks (followed by access to the website if desired). Individuals are included if they are over 16-years-old, have a diagnosis of asthma with an Asthma Control Questionnaire (ACQ) score of greater than, or equal to 1, and have access to the internet. Primary outcomes for this evaluation include recruitment and retention rates, changes at 12 weeks from baseline for both ACQ and Asthma Quality of Life Questionnaire (AQLQ) scores, and quantitative data describing website usage (number of times logged on, length of time logged on, number of times individual pages looked at, and for how long). Secondary outcomes include clinical outcomes (medication use, health services use, lung function) and patient reported outcomes (including adherence, patient activation measures, and health status).DiscussionPiloting of complex interventions is considered best practice and will maximise the potential of any future large-scale randomized controlled trial to successfully recruit and be able to report on necessary outcomes. Here we will provide results across a range of outcomes which will provide estimates of efficacy to inform the design of a future full-scale randomized controlled trial of the ‘Living well with asthma’ website.Trial registrationThis trial is registered with Current Controlled Trials ISRCTN78556552 on 18/06/13.

Improving Provider Compliance in the Use of an Asthma Action Plan for Patients With Asthma in an Outpatient Setting

Problem: Improved patient asthma outcomes have been demonstrated through the use of a symptom-based written asthma action plan (AAP) in reducing acute care visits (Gibson &amp; Powell, 2004). However, despite the research and guideline recommendations that support the use of AAPs, these plans are routinely not used by providers. The aim of this quality improvement (QI) project was to improve provider compliance in the use of a symptom-based AAP. Methods: A QI project was conducted in an outpatient setting involving an educational in-service on the use of an AAP. A retrospective medical record review was conducted following an educational in-service to assess the use and completeness of the AAP (N = 42). The rate of proportional change in compliance in the use of an AAP after the educational in-service and system procedural change was analyzed and reported. Results: A statistically significant improvement in provider compliance to the use and completion of a symptom-based AAP was found at 8 weeks following an educational in-service and system procedural change. Discussion: This QI project demonstrated the effectiveness of an educational in-service in improving provider compliance in the use of and the completion of a symptom-based AAP.