Decrease in hospitalization for treatment of childhood asthma with increased use of antiinflammatory treatment, despite an increase in the prevalence of asthma†

Wennergren, Göran; Kristjánsson, Sigurður; Strannegård, Inga-Lisa

doi:10.1016/s0091-6749(96)80150-3

Cited by 167 publications

(117 citation statements)

References 18 publications

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“…Earlier work has shown that hospital admissions and emergency department visits account for a substantial proportion of healthcare costs [33]. In the present study there were no hospitalisations or visits to the emergency department room for acute severe asthma, confirming that with the appropriate control of asthma, morbidity, hospitalisation and emergency department visits can be reduced [17,18]. For other populations with less optimal control the cost analysis may be less favourable.…”

Section: Discussionsupporting

confidence: 73%

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Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Kamps¹,

Roorda²,

Kimpen³

et al. 2004

Eur Respir J

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The high burden of asthma on healthcare utilisation and costs warrants economic appraisal of management approaches. The authors previously demonstrated that the efficacy of nurse-led outpatient management of childhood asthma was comparable to management by a paediatrician and now report on the healthcare utilisation and costs of both management approaches.A total of 74 newly referred children with asthma were randomly assigned to a 1-yr follow-up by paediatricians or asthma nurse. Healthcare utilisation was recorded and associated costs calculated for both management approaches.There were no significant differences in healthcare utilisation except for the total time spent on patient contact (136(n=14) versus 187(n=41) min, for patients followed-up by paediatrician and an asthma nurse repectively). Costs within the healthcare sector were reduced by 7.2% in favour of nurse-led care. The reduction in costs was solely attributable to a 17.5% reduction in the costs of outpatient visits. Nurse-led care appeared to be cost-saving even if the duration of follow-up visits would be twice that of doctor9s visits. Overall healthcare costs (within and outside the healthcare sector) were 4.1% lower for nurse-led outpatient management compared to traditional medical care.Nurse-led outpatient management of childhood asthma can be provided at a lower cost than medical care by paediatricians.

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Section: Discussionsupporting

confidence: 73%

“…In previous studies, it was shown that a reduction in healthcare utilisation, such as emergency department visits and hospitalisations, can be achieved with adequate asthma control [17,18]. Furthermore, maintenance treatment with inhaled corticosteroids has been shown to be cost effective [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Kamps¹,

Roorda²,

Kimpen³

et al. 2004

Eur Respir J

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“…PC service consumption has increased while inpatient hospital admission rates have declined. 3 Fleming et al 17 found 3 studies [18][19][20] showing decreased numbers of hospital admissions for asthma, and these results aroused speculation that more asthma attacks were treated in PC settings. Asthma is therefore perceived as a condition treated primarily in the community, by PCPs who manage both the chronic disease and acute episodes.…”

Section: Figurementioning

confidence: 99%

Seasonality of Asthma: A Retrospective Population Study

Cohen

Blau

Hoshen³

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Asthma is a clinical condition treated mostly at primary care community clinics. Epidemics of asthma exacerbation occur annually with return to school after summer vacation and have been reported in many countries, including Israel. WHAT THIS STUDY ADDS:In 82 234 asthmatic children, unscheduled primary care physician visits and drug prescriptions for asthma exacerbations peaked in September after a summer trough, with a lesser peak in late autumn and fluctuations through the winter months. abstract OBJECTIVES: Seasonal variations in asthma are widely recognized, with the highest incidence during September. This retrospective population study aimed to investigate whether this holds true in a large group of asthmatic children in primary care and to assess the impact of age, gender, urban/rural living, and population sector. METHODS:The key study outcomes were the diagnosis of asthma exacerbations and asthma medication prescriptions, recorded by family physicians during 2005 to 2009. These were analyzed by "week of diagnosis" in Clalit Health Services' electronic medical record database. Regression models were built to assess relative strength of secular trends, seasonality, and age-group in explaining the incidence of asthma exacerbations. RESULTS:A total of 919 873 children aged 2 to 15 years were identified. Of these, 82 234 (8.9%) were asthmatic, 61.6% boys and 38.4% girls; 49.1% aged 2 to 5 years, 24.1% 6 to 9 years, and 26.8% 10 to 15 years. We observed a 2.01-fold increase in pediatric asthma exacerbations and 2.28-fold increase in prescriptions of asthma bronchodilator medications during September (weeks 37-39 vs weeks 34-36) compared with August. The association between the opening of school and the incidence of asthma-related visits to the primary care physician was greatest in children aged 2 to 5 years (odds ratio, 2.15) and 6 to 11 years (1.90-fold). Adolescents (age 12-15 years) had a lesser peak (1.81-fold). In late fall there was a second rise, lasting with fluctuations throughout winter, with a trough in summer.CONCLUSIONS: Returning to school after summer is strongly associated with an increased risk for asthma exacerbations and unscheduled visits to the primary care physician. Pediatrics 2014;133:e923-e932 AUTHORS:

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“…It is well established that effective treatment of asthma is reliant upon patient adherence to daily treatment regimens. 7 Adherence to asthma medication regimens among children and adults is variable, with reported rates between 30% and 70%. 8,9 Studies have suggested a link between parental beliefs about medications and their child's adherence to asthma treatment.…”

mentioning

confidence: 99%

Complementary and Alternative Medicine Use and Adherence With Pediatric Asthma Treatment

Philp¹,

Maselli

Pachter

et al. 2012

Pediatrics

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BACKGROUND AND OBJECTIVE: Complementary and alternative medicine (CAM) use for pediatric asthma is increasing. The authors of previous studies linked CAM use with decreased adherence to conventional asthma medicines; however, these studies were limited by cross-sectional design. Our objective was to assess the effect of starting CAM on pediatric adherence with daily asthma medications. METHODS: We used a retrospective cohort study design. Telephone surveys were administered to caregivers of patients with asthma annually from 2004 to 2007. Dependent variables were percent missed doses per week and a previously validated “Medication Adherence Scale score.” Independent variables included demographic factors, caregiver perception of asthma control, and initiation of CAM for asthma. We used multivariate linear regression to assess the relationship between medication adherence and previous initiation of CAM. RESULTS: From our longitudinal data set of 1322 patients, we focused on 187 children prescribed daily medications for all 3 years of our study. Patients had high rates of adherence. The mean percent missed asthma daily controller medication doses per week was 7.7% (SD = 14.2%). Medication Adherence Scale scores (range: 4–20, with lower scores reflecting higher adherence) had an overall mean of 7.5 (SD = 2.9). In multivariate analyses, controlling for demographic factors and asthma severity, initiation of CAM use was not associated with subsequent adherence (P > .05). CONCLUSIONS: The data from this study suggest that CAM use is not necessarily “competitive” with conventional asthma therapies; families may incorporate different health belief systems simultaneously in their asthma management. As CAM use becomes more prevalent, it is important for physicians to ask about CAM use in a nonjudgmental fashion.

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Decrease in hospitalization for treatment of childhood asthma with increased use of antiinflammatory treatment, despite an increase in the prevalence of asthma†

Cited by 167 publications

References 18 publications

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Seasonality of Asthma: A Retrospective Population Study

Complementary and Alternative Medicine Use and Adherence With Pediatric Asthma Treatment

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