Can an evidence-based guideline reminder card improve asthma management in the emergency department?

To, Teresa; Wang, Chengning; Dell, Sharon D.; Fleming‐Carroll, Bonnie; Parkin, Patricia C.; Scolnik, Dennis; Ungar, Wendy J.

doi:10.1016/j.rmed.2010.03.028

Cited by 17 publications

(21 citation statements)

References 21 publications

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“…They also have recently been shown to improve compliance with evidence-based guidelines for asthma management (10). However, few studies have examined the role of pocket-cards in changing inpatient analgesic prescribing practices for children.…”

Section: Introductionmentioning

confidence: 99%

Analgesic Prescribing Practices Can Be Improved by Low-Cost Point-of-Care Decision Support

Rosenbluth

Wilson

Maselli

et al. 2011

Journal of Pain and Symptom Management

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Context Codeine has become a controversial choice for analgesia in children compared to other commonly available drugs. Objectives To evaluate whether an educational campaign shifted resident prescribing patterns away from codeine toward more appropriate analgesics. Methods Our intervention consisted of a pocket-sized reference card given to all trainees and key staff on an inpatient pediatric acute care unit; pediatrics residents also had the option to attend a one-hour lecture. The pocket-card recommended against codeine (including rationale), and gave prescription guidance for our institution’s preferred formulary alternative analgesics, which included tramadol and hydrocodone. We used inpatient prescribing data to track the prescribing of codeine and alternative medications over time. Results Following the interventions, there was a significant decrease in the percentage of patients receiving codeine (13.5% of patients received the drug in the year before, 5.4% in the year after, P<0.0001). Use of hydrocodone-containing analgesics increased overall during the same period (7.4% to 16%, P<0.0001) as did tramadol use (0.2% to 2.6%, P<0.0001). There were no changes in pain management satisfaction scores. Conclusions A simple, low-cost educational campaign consisting primarily of a pocket guide to analgesics markedly improved analgesic prescribing patterns, and that improvement extended to services not targeted by the didactic component of our educational campaign. Point-of-care decision support via a pocket-card may be sufficient for effecting change in medication prescribing patterns of trainees.

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Section: Introductionmentioning

confidence: 99%

Analgesic Prescribing Practices Can Be Improved by Low-Cost Point-of-Care Decision Support

Rosenbluth

Wilson

Maselli

et al. 2011

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

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“…However, despite the availability of clinical practice guidelines and efficacious treatment options, [9][10][11][12][13][14] asthma is not well controlled for many patients, 15 and poorer asthma control is associated with higher costs and increased resource use. [15][16][17][18] In addition, large gaps still exist between the care recommended by guidelines and that actually provided, [19][20][21][22][23][24][25][26][27][28] and there is an inadequate focus on self-management. 29 A study from the Rand Corporation published in 2007 showed that adherence to 17 recommended ambulatory care indicators for children with asthma was only 46%.…”

mentioning

confidence: 99%

Improving Outcomes for Underserved Adolescents With Asthma

et al. 2014

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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

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“…Studies have suggested lack of familiarity and lack of awareness of CPG as potential barriers to their use . Initiatives to improve systematic implementation of CPG, such as a system to monitor adherence to guidelines, use of opinion leaders to promote CPG use and reminder cards or evidence‐based asthma management protocols at the point of care, may improve adherence . In conclusion, the findings of this study provide comprehensive baseline assessment of paediatric asthma care across the entire patient journey (i.e.…”

Section: Discussionmentioning

confidence: 88%

Assessing appropriateness of paediatric asthma management: A population‐based sample survey

et al. 2019

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Background and objective We conducted a comprehensive assessment of guideline adherence in paediatric asthma care, including inpatient and ambulatory services, in Australia. Methods National and international clinical practice guidelines (CPG) relating to asthma in children were searched and 39 medical record audit indicator questions were developed. Retrospective medical record review was conducted across hospital inpatient admissions, emergency department (ED) presentations, general practice (GP) and paediatrician consultations in three Australian states for children aged ≤15 years receiving care in 2012 and 2013. Eligibility of, and adherence to, indicators was assessed from medical records by nine experienced and purpose‐trained paediatric nurses (surveyors). Results Surveyors conducted 18 453 asthma indicator assessments across 1600 visits for 881 children in 129 locations. Overall, the adherence for asthma care across the 39 indicators was 58.1%, with 54.4% adherence at GP (95% CI: 46.0–62.5), 77.7% by paediatricians (95% CI: 40.5–97.0), 79.9% in ED (95% CI: 70.6–87.3) and 85.1% for inpatient care (95% CI: 76.7–91.5). For 14 acute asthma indicators, overall adherence was 56.3% (95% CI: 47.6–64.7). Lowest adherences were for recording all four types of vital signs in children aged >2 years presenting with asthma attack (15.1%, 95% CI: 8.7–23.7), and reviewing patients’ compliance, inhaler technique and triggers prior to commencing a new drug therapy (20.5%, 95% CI: 10.1–34.8). Conclusion The study demonstrated differences between existing care and CPG recommendations for paediatric asthma care in Australia. Evidence‐based interventions to improve adherence to CPG may help to standardize quality of paediatric asthma care and reduce variation of care.

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Can an evidence-based guideline reminder card improve asthma management in the emergency department?

Cited by 17 publications

References 21 publications

Analgesic Prescribing Practices Can Be Improved by Low-Cost Point-of-Care Decision Support

Analgesic Prescribing Practices Can Be Improved by Low-Cost Point-of-Care Decision Support

Improving Outcomes for Underserved Adolescents With Asthma

Assessing appropriateness of paediatric asthma management: A population‐based sample survey

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