Allowing teens to control the timing and content of reminder text messages may support self-management of chronic disease.
BACKGROUND AND OBJECTIVE: Asthma is the most common chronic disease of childhood. Treatment adherence by adolescents is often poor, and their outcomes are worse than those of younger patients. We conducted a quality improvement initiative to improve asthma control and outcomes for high-risk adolescents treated in a primary care setting. METHODS:Interventions were guided by the Chronic Care Model and focused on standardized and evidence-based care, care coordination and active outreach, self-management support, and community connections. RESULTS:Patients with optimally well-controlled asthma increased from ∼10% to 30%. Patients receiving the evidence-based care bundle (condition/severity characterized in chart and, for patients with persistent asthma, an action plan and controller medications at the most recent visit) increased from 38% to at or near 100%. Patients receiving the required self-management bundle (patient selfassessment, stage-of-readiness tool, and personal action plan) increased from 0% to ∼90%. Patients and parents who were confident in their ability to manage their or their adolescent' s asthma increased from 70% to ∼85%. Patient satisfaction and the mean proportion of patients with asthma-related emergency department visits or hospitalizations remained stable at desirable levels.CONCLUSIONS: Implementing interventions focused on standardized and evidence-based care, self-management support, care coordination and active outreach, linkage to community resources, and enhanced followup for patients with chronically not-well-controlled asthma resulted in sustained improvement in asthma control in adolescent patients. Additional interventions are likely needed for patients with chronically poor asthma control. Pediatrics 2014;133:e418-e427 Drs Britto and Byczkowski conceptualized and designed the project, contributed to the acquisition of the data and analysis and interpretation of the results, and drafted the initial manuscript; Ms Vockell, Ms Munafo, Ms Wimberg, and Mr Pruett contributed to the conception and design the project, the acquisition of the data, and analysis and interpretation of the results; Ms Schoettker contributed to the analysis and interpretation of the results and drafted the initial manuscript; Dr Yi contributed to the conception and design of the project and helped to draft the initial manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi
Personal health records may enhance pediatric care and outcomes. Few systems have been developed or customized for pediatrics, and evaluations are scarce. Special considerations in pediatrics include pediatric content such as growth charts, complex privacy and confidentiality considerations, and the changing developmental needs of children and adolescents. Pediatrics 2009;123:S97-S99 P EDIATRICIANS HAVE LONG used tools such as immunization cards and well-child booklets to provide families with access to key information about their children's health. In the past 15 years, electronic records and the Internet have become increasingly important and available mechanisms through which to provide families with data about their children's health and to assist families in tracking their children's health and development. Families also create their own paper and electronic records of their children's health and health care needs. Electronic systems, known as personal health records (PHRs), may play key roles in enhancing partnerships between families and health care providers, promoting self-care, and enhancing family decision-making regarding the health of children and adolescents. Furthermore, they can provide key health information when a child becomes ill away from home or in a disaster. This article reviews PHR types and characteristics, summarizes some existing systems, and describes special challenges for PHRs in pediatrics.PHRs have been defined by the Markle Foundation as an "electronic application through which individuals can access, manage and share their health information, and that of others for whom they are authorized, in a private, secure, and confidential environment." 1 An ideal PHR would be lifelong and would integrate information from many sources, such as health care systems, pharmacies, and insurers, as well as family-entered information such as symptoms, health concerns, and self-monitoring findings. It would be controlled by the patient or family, and it would be private and secure. It would facilitate communication between families and providers, using functions such as secure e-mail. 1 No existing systems meet all of these criteria, partly because of the difficulty of merging data from multiple sources into a single data system. Privacy concerns and lack of a strong business case for PHRs have also hindered their development.In the early 1990s, many commercial vendors developed Internet-based, stand-alone systems. These systems required consumers to enter and to maintain their own health information. Although some of these systems remain, they have never become popular, likely because of the onerous nature of maintaining the information. Therefore, PHRs linked to electronic health records (EHRs) and other sources of health information have become the preferred model. 1,2 Recently, several large software makers announced their plans to develop secure PHRs that could link to physicians ' and hospitals' EHRs. 3,4 Once these systems overcome the technical challenges of integrating informatio...
The role of the pediatric nurse practitioner is becoming more complex with time. Both patients and the health care system are becoming more intricate. Effective support of the PNP can consist of a nonclinical professional who is a parent of a chronically ill child. Support including data entry, preclinic planning, self-management support, appointment scheduling, research, and between-visit follow-up can be provided from the perspective of a parent. This article will describe the role of a parent coordinator who was hired in part to provide support for a pediatric nurse practitioner in a primary care clinic for patients with asthma.
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