Asthma Treatment Decisions by Pediatric Residents Do Not Consistently Conform to Guidelines or Improve With Level of Training

Okelo, Sande O.; Siberry, George K.; Solomon, Barry S.; Bilderback, Andrew; Yamazaki, Masayoshi; Hetzler, Theresa; Ferrell, Cynthia L.; Dhepyasuwan, Nui; Serwint, Janet R.

doi:10.1016/j.acap.2013.12.008

Cited by 5 publications

(2 citation statements)

References 13 publications

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“…Pediatric residents have been shown to not consistently adhere to national asthma care guidelines regardless of level of training 3. Our baseline data demonstrated that pediatric residents in our teaching clinic at the University of California Davis Health System (California, United States) adhered to the national asthma care guidelines 20-35% of the time in terms of obtaining relevant history to diagnose severity of asthma, recommending spirometry testing, recommending influenza vaccine, using a standardized instrument to assess level of control, referring to national asthma care guidelines for medication dosage, and providing an asthma action plan.…”

Section: Problemmentioning

confidence: 99%

Improving asthma care in a pediatric resident clinic

Lee

Gogo

Tancredi

et al. 2016

BMJ Qual Improv Report

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There is variation in pediatric asthma management in the outpatient setting. Adherence to national asthma guidelines provides a systematic standardized approach to asthma management. There is a gap between usual and guideline-consistent asthma care in resident clinics. Practice improvement modules aimed at improving resident physician adherence to asthma care guidelines have not been consistently utilized and have not yet been studied.Our aim was to increase guideline consistent care in our pediatric resident clinic in a twelve-month period via increasing performance on the following measures to 75%: spirometry testing; influenza immunization recommendation; level of control assessed through the use of a standardized questionnaire; appropriate medications per national guideline; and use of written asthma action plans.A summarized pediatric-specific version of the National Heart Lung and Blood Institute National Asthma Education and Prevention Program Expert Panel Report 3 (NHLBI EPR-3) guidelines was made readily available to increase provider education. Electronic health record (EHR) enhancements included adding templates to create standardized asthma action plan, asthma control test and a pediatric asthma controller medication order-set. We also addressed the education of patients by simplifying patient instructions. We monitored our progress through the use of an online practice improvement module.We found statistically significant increases in use of a standardized instrument to determine level of control (20% to 81%); recommendation of influenza immunization (56% to 97%); use of national medication treatment guidelines (28% to 98%); distribution of asthma action plans (29% to 65%); and provision of asthma self-management education (35% to 74%).Standardizing the implementation of national guidelines for pediatric asthma through the use of a practice improvement module and electronic health records improved adherence to guidelines. The module allowed us to identify goals for improvement, collect and analyze our group performance data over time, assess the impact of each change, and redesign our process. Improving adherence to national pediatric asthma care guidelines is especially important in settings such as resident teaching clinics which provide care to underserved populations at higher risk for complications related to asthma.

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Section: Problemmentioning

confidence: 99%

Improving asthma care in a pediatric resident clinic

Lee

Gogo

Tancredi

et al. 2016

BMJ Qual Improv Report

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“…However, nonadherence extends beyond patients. Healthcare providers (HCP) conduct sub-standard assessments (7), lack familiarity with guidelines (8), and fail to impart essential selfmanagement skills (9). Furthermore, healthcare systems have limited resources to provide care (e.g.…”

Section: Introductionmentioning

confidence: 99%

Going mobile with primary care: smartphone-telemedicine for asthma management in young urban adults (TEAMS)

et al. 2020

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Background: The majority of adults with persistent asthma have chronically uncontrolled disease and interventions to improve outcomes are needed. We evaluated the efficacy, feasibility, and acceptability of a multi-component smartphone-telemedicine program (TEAMS) to deliver asthma care remotely, support provider adherence to asthma management guidelines, and improve patient outcomes. Methods: TEAMS utilized: (1) remote symptom monitoring, (2) nurse-led smartphone-telemedicine with self-management training for patients, and (3) Electronic medical recordbased clinical decision support software. Adults aged 18-44 (N ¼ 33) and primary care providers (N ¼ 4) were recruited from a safety-net practice in Upstate New York. Asthma control, quality of life, and FEV 1 were measured at 0, 3 and 6 months. Acceptability was assessed via survey and end-of-study interviews. Paired t-test and mixed effects modeling were used to evaluate the effect of the intervention on asthma outcomes. Results: At baseline, 80% of participants had uncontrolled asthma. By 6-months, 80% classified as well-controlled. Improvements in control and quality of life were large (d ¼ 1.955, d ¼ 1.579). FEV %pred increased 4.2% (d ¼ 1.687) with the greatest gain in males, smokers, and lower educational status. Provider adherence to national guidelines increased from 43.3% to 86.7% (CI ¼ 22.11-64.55) and patient adherence to medication increased from 45.58% to 85.29% (CI ¼ 14.79-64.62). Acceptability was 95.7%; In follow up interviews, 29/30 patients and all providers indicated TEAMS worked better than usual care, supported effective selfmanagement, and reduced symptoms over time, which led to greater self-efficacy and motivation to manage asthma. Discussion: Based on these findings, we conclude that smartphone telemedicine could substantially improve clinical asthma management, adherence to guidelines, and patient outcomes.

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