Nurse-delivered outpatient asthma education for children and caregivers: a pilot study to promote shared asthma management

Frey, Sean M.; Contento, Nicholas; Halterman, Jill S.

doi:10.1080/02770903.2019.1692028

Cited by 6 publications

(2 citation statements)

References 39 publications

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“…To improve the comfort of PCPs to prescribe ICS, asthma education programs have been developed that can be delivered in-person by trained educators to PCPs in their o ce. Studies have shown that asthma education programs are effective in improving guideline-based provider and patient management of asthma, as well as reducing frequency of asthma symptoms in patients (24,25,(27)(28)(29)(30). Findings reported included improvements in rates of appropriate ICS prescriptions, written asthma action plans, use of a spacer, and reduction of ED visits and hospitalizations for pediatric asthma patients (25,27,(29)(30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

Referral Patterns To Pediatric Pulmonology For Asthma-Like Symptoms

Garland

Mirea

et al. 2021

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Background: The decision to refer a sick child to a pediatric specialist is important for health care quality, however access to specialty care is worsening. Referrals from primary to specialty care are a critical first step in coordinating specialty care, but there are often shortcomings in the appropriateness, clarity, and completeness of referrals. This study aimed to characterize referrals for asthma-like symptoms to a pediatric pulmonology clinic, evaluate consult interventions, and identify opportunities for improving access. Methods: A retrospective chart review examined patients ages 5-18 years, referred to the pulmonology clinic at Phoenix Children’s Hospital between July 2016 and July 2019. Descriptive statistics summarized demographics, prior asthma diagnosis, ICS use and compliance, reason for referral and intervention during consult. An appropriate referral was defined as prior asthma and ICS Step 3. Results: The total 171 study subjects had mean (standard deviation) age of 9.4 (3.8) years, with 100 (58%) males, and prior asthma diagnosis in 105 (61%). The most common reason for pulmonology referral was asthma in 90 (53%) patients, of which 70 (78% of 90) had prior asthma. Among 105 patients with asthma, 79 (76%) had a history of ICS, with 33 (42% of 79) patients reporting spacer compliance issues. The rate of appropriate referrals was 0.11 (95% confidence interval: 0.06-0.16). During the pulmonology consult, nearly half 10 (53%) of 19 patients appropriately referred received an ICS step up. Among 151 inappropriate referrals, ICS was initiated for 91 (60%) and increased for 45 (30%). Education was provided to all patients during pulmonology consult. Conclusions: Mild-to-moderate asthma can be effectively treated by primary care providers (PCPs) with implementation of ICS, thus prioritizing healthcare resource utilization by enabling the pulmonologist to see higher acuity patients sooner. Further study is warranted to identify strategies and tools for PCPs to optimize asthma management.

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Section: Discussionmentioning

confidence: 99%

Referral Patterns To Pediatric Pulmonology For Asthma-Like Symptoms

Garland

Mirea

et al. 2021

Preprint

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“…A multicentre pilot hybrid-2 randomised effectiveness–implementation trial60 in children ≥2 months and <4 years admitted to a regional PICU will be used to simultaneously collect data on the effectiveness and implementation of the DAISY Pilot intervention. This design has been selected because: (1) there is evidence supporting the benefit of both early screening and intervention on child outcomes,19 21 24 61 and parent-directed interventions on parental stress and confidence and child outcomes34 62–68; (2) there is limited evidence supporting the implementation of follow-up for PICU survivors and evidence supporting objective outcomes and long-term follow-up adoption is currently lacking69; and (3) with appropriate support and education, there is minimal risk in implementing parent-directed follow-up interventions 70. The hybrid design permits important data to be collected on the transferability of evidence of effectiveness of separate elements of online screening, routine feedback and shared care in the proposed model while expediting translation of findings into clinical practice and survivor follow-up pathways 60…”

Section: Methodsmentioning

confidence: 99%

Effectiveness–implementation hybrid-2 randomised trial of a collaborative Shared Care Model for Detecting Neurodevelopmental Impairments after Critical Illness in Young Children (DAISY): pilot study protocol

et al. 2022

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IntroductionIn Australia, while paediatric intensive care unit (PICU) mortality has dropped to 2.2%, one in three survivors experience long-term neurodevelopmental impairment, limiting their life-course opportunities. Unlike other high-risk paediatric populations, standardised routine neurodevelopmental follow-up of PICU survivors is rare, and there is limited knowledge regarding the best methods. The present study intends to pilot a combined multidisciplinary, online screening platform and general practitioner (GP) shared care neurodevelopmental follow-up model to determine feasibility of a larger, future study. We will also assess the difference between neurodevelopmental vulnerability and parental stress in two intervention groups and the impact of child, parent, sociodemographic and illness/treatment risk factors on child and parent outcomes.Methods and analysisSingle-centre randomised effectiveness–implementation (hybrid-2 design) pilot trial for parents of children aged ≥2 months and <4 years discharged from PICU after critical illness or injury. One intervention group will receive 6 months of collaborative shared care follow-up with GPs (supported by online outcome monitoring), and the other will be offered self-directed screening and education about post-intensive care syndrome and child development. Participants will be followed up at 1, 3 and 6 months post-PICU discharge. The primary outcome is feasibility. Secondary outcomes include neurodevelopmental vulnerability and parental stress. An implementation evaluation will analyse barriers to and facilitators of the intervention.Ethics and disseminationThe study is expected to lead to a full trial, which will provide much-needed guidance about the clinical effectiveness and implementation of follow-up models of care for children after critical illness or injury. The Children’s Health Queensland Human Research Ethics Committee approved this study. Dissemination of the outcomes of the study is expected via publication in a peer-reviewed journal, presentation at relevant conferences, and via social media, podcast presentations and open-access medical education resources.Registration detailsThe trial was prospectively registered with the Australian New Zealand Clinical Trials Registry as ‘Pilot testing of a collaborative Shared Care Model for Detecting Neurodevelopmental Impairments after Critical Illness in Young Children’ (the DAISY Pilot Study).Trial registration numberACTRN12621000799853.

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