A Community-Based Strategy for Improving Asthma Management and Outcomes for Preschoolers

Abstract

Although almost one in ten (8.6%) preschool children has been diagnosed with asthma, few asthma management programs are designed for parents of preschool children. The Asthma Basics for Children program addressed this need in 2003-2008 by implementing a multi-layered approach that offered educational activities to center staff, parents, and children and PACE training to physicians in 31 Northern Manhattan daycare centers. Following program participation, 85% of parents reported reducing their child's triggers, 89% said it was easier to talk to their child's physician, and 80% were confident in their ability to manage their child's asthma. Children's any daytime symptoms dropped from 78% to 42%, any nighttime symptoms from 81% to 49%, any daycare absences from 56% to 38%, any asthma-related emergency department (ED) visits from 74% to 47%, and any asthma-related hospitalizations from 24% to 11% (p < .001 for all differences). Outcomes varied by level of exposure. In the Center-Only group (no parent participation), the only reduction was from 19% to 10% (McNemar = 3.77, p = .052) in hospitalizations. Children whose parents participated in the program had significant reductions in daycare absences (62% to 38%, McNemar = 11.1, p < .001), ED visits (72% to 43%, McNemar = 19.2, p < .001), and hospitalizations (24% to 11%, McNemar = 5.54, p = .018). Children whose parents and healthcare provider participated had the greatest improvements with asthma-related daycare absences dropping from 62% to 32% (McNemar = 9.8, p = .001), ED visits from 72% to 37% (McNemar = 14.4, p < .001), and hospitalizations from 35% to 15% (McNemar = 8.33, p = .003). This study demonstrates that a multi-layered approach can improve asthma outcomes among preschoolers with a combination of parent and provider education having the greatest impact.

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

“…We included 19 papers reporting 18 studies (see Table 116 for details) nine of which were conducted in the USA, 219,220,[222][223][224][225]230,231,234 four from the UK, 218,226,228,236 two from Brazil, 229,235 one (two reports) from Finland 232,233 and two from other European countries. 221,227 The majority (n = 9) were conducted in primary care or community settings, 218,219,226,228,229,[234][235][236] four in managed care organisations (MCOs), 220,222,223,225 one in secondary care, 230 three in schools 221,224,231 and one (two reports) was a national multisetting initiative.…”

“…221,227 The majority (n = 9) were conducted in primary care or community settings, 218,219,226,228,229,[234][235][236] four in managed care organisations (MCOs), 220,222,223,225 one in secondary care, 230 three in schools 221,224,231 and one (two reports) was a national multisetting initiative.…”

“…228 Seven were based on longitudinal data, 220,223,[230][231][232][233][234][235] one with a control cohort, 229 and two uncontrolled before-and-after 221,236 or cross-sectional studies. 227 This resulted in substantial variation in quality assessment, ranging from 10 to 24 out of a possible score of 28.…”

“…Three studies used population data to observe the impact of multifaceted public health programmes on admissions, 229,232,233,235 two quality improvement projects aimed to promote asthma self-management 230,236 and two complex interventions targeted low-income communities in US cities. 231,234 A national programme to improve asthma care in Finland 232,233 included a strong focus on self-management education, in the context of widespread professional education-and systems-level expectations of raising the quality of asthma diagnosis and management. Routine data over the decade of the intervention showed increased use of preventer medication and a reduction in hospital admissions and emergency visits, 232 which was maintained after the end of the programme.…”

“…In the context of pre-school centres, Findley et al 231 provided educational activities for parents and training for community professionals (social workers, teachers) in implementing 'asthma-friendly' initiatives and physician asthma care education training to the childrens' physicians. The intervention was associated with improved markers of asthma control and a reduction in hospitalisations, but the greatest benefits were in children exposed to a combination of pre-school centre, parent and physician components of the intervention.…”