LEAP: A randomized–controlled trial of a lay-educator inpatient asthma education program

Systematic meta-review of supported self-management for asthma: a healthcare perspective

“…FU: 6 moBetween-group improvement in parents’ self-efficacy and childs’ ‘eczema behaviour’, but not equivalent asthma outcomes.Parent and family generic QoL improved ( p  = 0.01).Plaza 2015 [65]230 participantsTrained practices (I) vs. specialist unit (I s ) vs. usual care (C).Impact:Components: Education programmeBasic information on asthma, inhaler technique; provision of a PAAP.Adults with persistent asthma.Cluster RCT. FU: 12 moI groups had fewer unscheduled visits [I: 0.8 (SD 1.4) and I s : 0.3 (SD 0.7) vs. C:1.3 (SD 1.7); p  = 0.001], and greater improvements in asthma control ( p  = 0.042) and QoL ( p  = 0.019).Rice 2015 [66]711 participantsPAAP + inpatient lay educator vs. PAAP.Components: Inpatient lay educatorEncourage FU attendance, build self-efficacy, set goals, overcome barriers.Children 2–17 y admitted with asthma.RCT.FU: 1 moNo difference in attendance at FU appointment. I group had greater preventer use (OR 2.4, 95% CI 1.3–4.2), PAAP ownership (OR 2.0, 95% CI 1.3–3.0) and improved self-efficacy ( p  = 0.04).Yeh 2016 [67]76 participantsFamily programme (+PAAP) vs. usual care (+PAAP).Components: Family empowermentFamily empowerment to reduce parental stress, increase family functioning.Children 6–12 y with asthma.RCT.FU: 3 moI families had reduced parental stress index ( p  = 0.026) and improved family environment scores ( p  < 0.0001), improved lung function, less disturbed sleep, less cough but no difference in wheeze.Zairina 2016 [68]72 participantsTelehealth supported PAAP vs. usual care.Components: TelehealthTelehealth (FEV 1 , symptoms) monitored weekly.Pregnant women with moderate/severe asthmaRCT.FU: 6 moTelehealth improved ACQ [MD 0.36 (SD 0.15, 95% CI −0.66 to −0.07)] and mAQLQ [MD 0.72 (SD 0.22; 95% CI 0.29–1.16)].No difference in perinatal outcomes.

Abbreviations : ACQ Asthma Control Questionnaire, AQLQ Asthma Quality Of Life Questionnaire, C control, CI confidence interval, FEV 1 forced expiratory volume in one second, FU follow-up, I intervention, LTC long-term condition, mAQAL mini Asthma Quality Of Life Questionnaire, MD mean difference, mo month, OR odds ratio, PAAP personalised asthma action plan, QoL quality of life, RCT randomised controlled trial, SD standard deviation, SMD standardised mean difference, y year

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Parental Management of Discharge Instructions: A Systematic Review

“…36 Improved adherence was seen with interventions involving standardized printed instructions, 36 a physician dosing demonstration and observed dosing, 62 and tailored education sessions. 51 Variables associated with more medication errors included having multiple medications, 61,81 limited English proficiency, 75,90 older child age, 37,38,59,78 and public or no insurance. 37,81,84 Follow-up Appointments (34 Studies) Researchers for 3 studies assessed knowledge of follow-up appointment instructions, 53,56,61 with up to 64% of parents not being aware of important follow-up information.…”

“…** Between 28% and 62% of families missed appointments after inpatient discharge. 51,55,70,71 Between 16% and 81% of parents missed follow-up appointments after ED visits. † † Factors associated with and/or barriers identified by parents to missed follow-up appointments included a diagnosis of low acuity (parental report or diagnoses predefined by authors), 73,77,84,85 having public or no insurance, 41,43,84,85 being of a minority race/ethnicity, 42,43 having an older child, 41,43 having multiple appointments, 61,71 being non-English speaking, 42,85 and having school or work conflicts.…”

Medication adherence in pediatric asthma: A systematic review of the literature

“…Similar to the individual domain, a number of studies assessed how family factors, health beliefs, and knowledge are related to adherence. Targeting asthma knowledge can promote increased medication usage; however, these effects often diminish when the intervention is not present . Inaccurate parental report of disease (eg, asthma is an intermittent condition) and medication knowledge (eg, name of medication, proper administration of medication, course, and efficacy of medication) are associated with poorer adherence .…”

“…All but two studies found asthma education to improve adherence. Education associated with improvement in adherence came in the form of asthma action plans, education about peak flow meters, asthma self‐management instruction, and providing feedback on patient adherence . Improved adherence is associated with teaching psychological and behavioral techniques, such as contingency management, problem solving training, and parent skill training …”