Parental Knowledge and Use of Preventive Asthma Care Measures in Two Pediatric Emergency Departments

Abstract

Objectives-Parents of children who visit the pediatric emergency department (PED) for asthma exacerbations may not receive adequate instruction in preventive asthma care. Our primary objective was to assess knowledge and use of preventive asthma care measures among parents of children with asthma who present to the PED with asthma exacerbations. Our secondary objective was to identify variables that predict adherence to four key preventive care measures.Methods-We administered a 38-item questionnaire to 229 parents of children ages 2 to 18 years with asthma exacerbations who presented to two, urban PEDs, one in the southeast and one in the northwest U.S. Descriptive statistics were calculated to assess parental knowledge of preventive care. Multivariable logistic regression was used to identify variables associated with the use of four key preventive care measures.Results-Thirty-two percent of the children had an action plan, 29% of children ≥ 5 years of age had a peak flow meter, and 52% received the influenza vaccine within the preceding year. Sixtysix percent of the children had persistent asthma by NIH criteria. Of these, 51% received daily inhaled corticosteroids (ICS). When parents were asked how an ICS medicine worked, 29% (64/221) responded "immediately opens the airway", and 24% (53/221) responded "I do not know." Daily use of ICS in these children was significantly associated with parent education level beyond high school (OR=2.81; 95% CI: 1.26, 6.24; P=0.01). Non-African Americans were more likely to have received an action plan than African Americans (OR=2.18; 95% CI:1.17, 4.06; P=0.01). A secondary analysis of the parent's perception of his/her ability to provide care during an asthma exacerbation was significantly associated with receipt of an action plan in a multivariable proportional odds model (OR=3.63; 95% CI: 1.99, 6.62; P<0.001).Corresponding author: Jamie N. Deis, MD, 1100 Sweetflag Lane, Hillsborough, NC 27278, Phone: 615-476-4197, jdeis@wfubmc.edu. Conclusions-Parents of children with persistent asthma presenting to urban tertiary care PEDs with asthma exacerbations frequently have inadequate understanding of appropriate ICS use. Parents with less than a high school education, in particular, may benefit from focused educational interventions which address the importance of daily ICS use in asthma control. Parents who receive a written action plan are more confident in their ability to provide care for their child during an asthma exacerbation. NIH Public AccessAuthor Manuscript J Asthma. Author manuscript; available in PMC 2013 November 19.

Improving Outcomes for Underserved Adolescents With Asthma

“…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%.…”

Knowledge and attitudes about pediatric sleep apnea among parents in an orthodontic clinic

“…Deis ve ark. 'ları 25 astımı olan çocuklarda ilaçların kullanım düzeyinin ebeveynin eğitim düzeyi lise seviyesinin üstüne çıktığında arttığını ve bu ebeveynlerin tedavi konusunda daha bilgili olduğunu rapor etmişlerdir. Schreck ve Richdale 20 ise üniversite ve üstü düzeyde eğitimi olan bireylerle olmayan bireyler arasında çocuk-larda uyku bozukluklarıyla ilgili bilgi düzeyinin anlamlı bir fark göstermediğini bulmuşlardır.…”

Emergency department visits for children with acute asthma: discharge instructions, parental plans, and follow-through of care—a prospective study

“…A multicomponent system of follow-up care that relies less on brief interactions with patients in the ED is essential. Effective mechanisms for delivering asthma education and improving follow-up care include written action plans, 16,17 video-based education, 18 and postdischarge text messaging. 19 Additional strategies could include automatic reminder telephone calls to see the family physician, education from the pharmacist, access to online resources, and immediate discharge notes sent to the family physician to alert them of the ED visit.…”