Initiating Inhaled Steroid Treatment for Children With Asthma in the Emergency Room

Andrews, Annie Lintzenich; Teufel, Ronald J.; Basco, William T.

doi:10.1097/pec.0b013e3182a219d0

Cited by 13 publications

(8 citation statements)

References 24 publications

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“…Ensuring the proper medications and devices are prescribed, picked up from the pharmacy, and are available for use is crucial for proper asthma care. Many roadblocks interfere with this process, including parent-child relationships, 54 disjointed care, providers not prescribing necessary medications, 55–56 familial beliefs, understanding or attitudes regarding the prescribed medications themselves or their necessity, 57–58 caregiver stress and depression, language barriers, and cost of medications. Leading open discussions to patient specific barriers to medications, encouraging medications to be brought with on every visit and addressing the medication reconciliation in a deliberate way may address some of these concerns.…”

Section: Discussionmentioning

confidence: 99%

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What Really Happens in the Home: The Medication Environment of Urban, Minority Youth

Pappalardo

Karavolos

Martin

2017

The Journal of Allergy and Clinical Immunology: In Practice

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Background Asthma disproportionately affects minority youth. Understanding the home medication environment and its relation to medication adherence can shape interventions to improve health outcomes. Objective To describe the asthma medication environment in the homes of urban minority youth and to determine predictors of medication use and technique in this population. Methods Baseline data from two cohorts of minority youth with asthma in Chicago were combined for cross-sectional analysis. Bilingual research assistants (RAs) collected data in the home. RAs asked caregivers and children to self-report medications using pictures and observed children’s asthma medications and inhaler technique. Results The sample contained 175 mainly Latino youth (85.6%) ranging from 5–18 years old. Most were on public insurance (80%) and had uncontrolled asthma by self-report (89.7%). Only 27.4% had a spacer, 74.9% had a quick relief medicine and 48.6% had any controller medicine. RA observations of controllers agreed with children (36%) and parental self-report (42.3%) but did not match the specific observed controllers. Children reported less parental help with medications (43%) than their parents (58.1%). One child was able to properly demonstrate 100% of the inhaler steps and 35.6% achieved >70% of inhaler steps. Better medication technique was associated with having a controller (b=12.2, SE=3.0, p <0.0001), quick reliever (b=8.05, SE=3.5, p=0.023) and a spacer (b=9.3, SE=3.54, p=0.009). Conclusions This rigorous evaluation of the home medication environment of high risk youth demonstrated that many families lack critical medications, devices, and technique for proper management of asthma.

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Section: Discussionmentioning

confidence: 99%

“…spacer) and new devices with different techniques continue to be released. 55 Lack of standardization of correct inhaler technique steps is an additional problem. National guidelines for technique and systematically measuring inhaler technique in the office are necessary to improve medication delivery in asthma.…”

Section: Discussionmentioning

confidence: 99%

What Really Happens in the Home: The Medication Environment of Urban, Minority Youth

Pappalardo

Karavolos

Martin

2017

The Journal of Allergy and Clinical Immunology: In Practice

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“…At the onset of this project overcoming cultural barriers to providing preventive care delivery in the PED was critical. As our survey noted, many ED physicians reported that prescribing long-term medications is outside their role [9]. This belief likely contributed to delays in the success of our interventions.…”

Section: Discussionmentioning

confidence: 75%

“…In addition to being more clinically effective, we determined that prescribing or dispensing ICS at the time of ED discharge would also generate cost-savings. We then developed a survey to assess the current rates of ICS prescribing among members of the American Academy of Pediatrics Section on Emergency Medicine [9]. The majority of respondents reported prescribing ICS 25% of the time or less and cited unclear guidelines, a belief that long-term medication prescribing is not within their role, and an inability to see patients in follow-up as important barriers.…”

Section: Introductionmentioning

confidence: 99%

Quality improvement methods improve inhaled corticosteroid prescribing in the emergency department

et al. 2014

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“…The strong endorsement of specific training sessions, decision-support tools, reminders, and pharmacy reports of drug claims to support the general management approach is aligned with prior studies [ 32 ]. In these studies, physicians voiced, as barriers to optimal asthma management, their confidence about capabilities in prescribing, and beliefs about consequences of, long-term ICS, as well as their worry about patients' noncompliance and the absence of patient follow-up [ 10 , 33 , 34 ]. In addition, key resources that increase physician's reported comfort in prescribing long-term ICS and perceived patient adherence were endorsed for patient-specific management, presumably because of more certainty in the management decision (i.e., lung function testing, specialist's opinion, and access to an asthma clinic), greater degree of collaborative care and patient follow-up (i.e., patient guidance and education provided by a paramedical healthcare professional) [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Enablers of Physician Prescription of a Long-Term Asthma Controller in Patients with Persistent Asthma

Ducharme

Lamontagne

Blais

et al. 2016

Canadian Respiratory Journal

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Objective. We aimed to identify key enablers of physician prescription of a long-term controller in patients with persistent asthma. Methods. We conducted a mailed survey of randomly selected Quebec physicians. We sent a 102-item questionnaire, seeking reported management regarding one of 4 clinical vignettes of a poorly controlled adult or child and endorsement of enablers to prescribe long-term controllers. Results. With a 56% participation rate, 421 physicians participated. Most (86%) would prescribe a long-term controller (predominantly inhaled corticosteroids, ICS) to the patient in their clinical vignette. Determinants of intention were the recognition of persistent symptoms (OR 2.67), goal of achieving long-term control (OR 5.31), and high comfort level in initiating long-term ICS (OR 2.33). Decision tools, pharmacy reports, reminders, and specific training were strongly endorsed by ≥60% physicians to support optimal management. Physicians strongly endorsed asthma education, lung function testing, specialist opinion, accessible asthma clinic, and paramedical healthcare professionals to guide patients, as enablers to improve patient adherence to and physicians' comfort with long-term ICS. Interpretation. Tools and training to improve physician knowledge, skills, and perception towards long-term ICS and resources that increase patient adherence and physician comfort to facilitate long-term ICS prescription should be considered as targets for implementation.

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Initiating Inhaled Steroid Treatment for Children With Asthma in the Emergency Room

Cited by 13 publications

References 24 publications

What Really Happens in the Home: The Medication Environment of Urban, Minority Youth

What Really Happens in the Home: The Medication Environment of Urban, Minority Youth

Quality improvement methods improve inhaled corticosteroid prescribing in the emergency department

Enablers of Physician Prescription of a Long-Term Asthma Controller in Patients with Persistent Asthma

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