Improving Care for Minority Children With Asthma: Professional Education in Public Health Clinics

Evans, David; Mellins, Robert B.; Löbach, Katherine S.; Ramos-Bonoan, Carmen; Pinkett-Heller, Marcia; Wiesemann, Sandra; Klein, Ilene; Donahue, Caroline; Burke, Dave; Levison, Moshe J.; Levin, Bruce; Zimmerman, Barry J.; Clark, Noreen M.

doi:10.1542/peds.99.2.157

Cited by 142 publications

(89 citation statements)

References 17 publications

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“…Recent evidence suggests that deficient asthma care often found among economically disadvantaged health care facilities can be rectified with education and supportive programs. 35 Such changes are unlikely to occur on a broad scale, however, without massive and sustained effort. Such reform must be championed not only by the federal government but also by health care providers and organizations, the pharmaceutical industry, community and civic associations, patient advocacy groups, and the patients themselves.…”

Section: Discussionmentioning

confidence: 99%

Race/Ethnicity and Asthma Among Children Presenting to the Emergency Department: Differences in Disease Severity and Management

et al. 2003

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ABSTRACT. Objective. To investigate racial/ethnic differences in acute asthma among children who present to the emergency department (ED).Method. We analyzed data from 2 prospective cohort studies performed during 1997-1998 as part of the Multicenter Airway Research Collaboration. Using a standardized protocol, researchers at 40 EDs in 18 US states provided 24-hour-per-day coverage for a median of 2 weeks per year. Children with acute asthma were interviewed in the ED and by telephone 2 weeks after discharge.Results. Among 1095 patients, 679 (62%) were black, 256 (23%) were Hispanic, and 160 (15%) were white. Black and Hispanic children had greater histories of lifetime (63%, 64%, 46%) and past-year (34%, 31%, 14%) hospitalization and more ED visits in the past year (medians: 2, 3, 1). Asthma severity at ED presentation, ED management and course, hospitalization during the index visit, discharge prescriptions, and postdischarge outcomes were equivalent among all race/ethnic groups.Conclusion. Despite pronounced race/ethnicity-based differences in chronic asthma, all racial/ethnic groups exhibited similar acute asthma severity, ED management, and course. However, given that black and Hispanic children exhibited much higher admission histories and past ED use, the equivalence in inhaled corticosteroid prescriptions on discharge is a disconcerting pattern that mirrors previous literature on outpatient prescription practices. In addition to barriers attributable to socioeconomic factors, health care providers and policy makers should target equalizing deficiencies in preventive medication prescription practices. Pediatrics 2003;111:e615-e621. URL: http://www.pediatrics.org/cgi/content/full/111/5/e615; asthma, children, socioeconomic status, race, ethnicity, quality of care.ABBREVIATIONS. ED, emergency department; MARC, Multicenter Airway Research Collaboration; PCP, primary care provider; SES, socioeconomic status. D espite effective therapies, asthma prevalence, morbidity, and mortality among children is increasing in the United States, and the burden is being borne disproportionately by blacks and Hispanics. Previous studies have focused primarily on racial/ethnic disparities noted in chronic care and management and have relied heavily on archival or billing data. To examine further the role of race/ ethnicity on asthma among children who present to the emergency department (ED), we examined prospective data from the Multicenter Airway Research Collaboration (MARC). On the basis of previous research, we hypothesized that black and Hispanic children with asthma would 1) exhibit more severe respiratory distress on arrival to the ED, 2) receive less adequate care while in the ED, 3) be admitted more often from the ED during their index visit, and 4) be more likely to relapse or have continued symptoms during the 2 weeks postdischarge. We further hypothesized that sociodemographic factors (including parental education, income, and insurance status) and access to a primary care provider (PCP) would play an important r...

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Section: Discussionmentioning

confidence: 99%

Race/Ethnicity and Asthma Among Children Presenting to the Emergency Department: Differences in Disease Severity and Management

et al. 2003

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“…[1][2][3] Moreover, asthma imposes a disproportionate burden on ethnic and racial minorities and poor children. 4,5 Current information suggests that factors other than environmental and household risks are major contributors to the high asthma diagnosis rates and poor asthma control observed among racial minorities. 6 -8 Factors that contribute to the differences in asthma rates and control between minority and nonminority children include diagnosing patterns, parental perceptions of asthma, quality of and access to health care, and, most notably, medication utilization.…”

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confidence: 99%

Impact of Site of Care, Race, and Hispanic Ethnicity on Medication Use for Childhood Asthma

et al. 2002

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ABSTRACT. Objective. To understand the importance of source of care and other factors that influence differences in asthma medication use by race and Hispanic ethnicity.Methods. The Childhood Asthma Severity Study provided 12-month, retrospective, parent-reported questionnaire data on a monthly basis for children ages <12 years in a community sample of 1002 children and their families from Connecticut and Massachusetts. Medications considered included cromolyn, ␤2-agonist, inhaled steroids, anticholinergics, theophylline, and systemic steroids. Information was available on demographics, insurance status, symptom severity, primary care contact, and provider practice types.Results. Black and Hispanic children received fewer ␤2-agonists, and Hispanic children received fewer inhaled steroids than white children after adjusting for patients' race, age, gender, insurance status, symptom severity, number of primary care visits for asthma, number of urgent visits to the regular provider, family income, maternal education, and site of care. When multivariate analyses were restricted to patients in private practice, the significant association between Hispanic ethnicity and low inhaled steroid use persisted, whereas differences in ␤2-agonist use by race and ethnicity changed little but became nonsignificant.Conclusion. Even within private practices, patients' race and ethnicity are associated with clinician nonadherence to national guidelines. Programs to eliminate these disparities will need both to focus on site of care and to intervene at the provider and patient levels to be successful. Pediatrics 2002;109(1). URL: http://www. pediatrics.org/cgi/content/full/109/1/e1; asthma, child, practice guidelines, health insurance, Hispanic Americans.

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“…Thus, we believe that the similar performance of our pediatric residents, irrespective of their level of training, reflects the rapid acquisition of basic asthma knowledge and the inability of the questionnaire to assess advanced knowledge. More focused questionnaires have been used to assess knowledge after specific educational programs (9)(10)(11)(32)(33)(34). However, the knowledge tested in these questionnaires often is too focused.…”

Section: Discussionmentioning

confidence: 99%

What Do Nurses and Residents Know about Childhood Asthma?

Lemay

Moore

Zegray

et al. 1999

Canadian Respiratory Journal

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OBJECTIVES:To assess residents' and pediatric nurses' basic knowledge of childhood asthma and to identify areas needing educational reinforcement. DESIGN: Survey using a validated self-administered questionnaire containing 25 true-false and six short open-ended questions. PARTICIPANTS: Pediatric residents and family medicine residents who were on rotation at a tertiary care pediatric hospital over a six-month period, and pediatric nurses on duty in the emergency department, on the wards and on the pediatric intensive care unit over a month period. RESULTS: The participation rate was 80% (28 of 35) of pediatric residents, 89% (33 of 37) of family medicine residents, and 50% (81 of 163) of pediatric nurses. The mean score (± standard deviation) on the 31-point questionnaire was 27.7±1.8 for pediatric residents, 25.5±3.6 for family medicine residents, and 22.3±3.8 for pediatric nurses (ANOVA, P<0.001). Most (at least 75%) participants correctly identified bronchospasm and airway inflammation as two potential mechanisms of asthma and were able to list three routinely used drugs to treat exacerbations. However, 32% of pediatric residents, 12% of family medicine residents and 72% of pediatric nurses failed to identify all three main symptoms of asthma (wheezing, cough, dyspnea). Although most participants recognized that children with frequent exacerbations should receive prophylactic therapy, 25% of pediatric residents, 52% of family medicine residents and 81% of pediatric nurses were unable to name at least two preventive asthma medications. More than 50% of participants could not name two drugs used in the prevention of exerciseinduced asthma. CONCLUSIONS: Residents and nurses had adequate basic knowledge of the treatment of acute exacerbations. However, most individuals needed reinforcement in preventive asthma therapy and daily management.

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Improving Care for Minority Children With Asthma: Professional Education in Public Health Clinics

Abstract: We conclude that the intervention substantially increased the Bureau of Child Health staff's ability to identify children with asthma, involve them in continuing care, and provide them with state-of-the-art care for asthma.

Cited by 142 publications

References 17 publications

Race/Ethnicity and Asthma Among Children Presenting to the Emergency Department: Differences in Disease Severity and Management

Race/Ethnicity and Asthma Among Children Presenting to the Emergency Department: Differences in Disease Severity and Management

Impact of Site of Care, Race, and Hispanic Ethnicity on Medication Use for Childhood Asthma

What Do Nurses and Residents Know about Childhood Asthma?

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