Process Improvement for Asthma

Abstract

At least 18 million people in the United States have asthma. Despite the publication of national guidelines, the delivery of care has not substantially changed. This article describes a program at Chicago city sites to improve the delivery of care to adults and children with asthma. Using consistent comprehensive patient education materials, innovative provider education, and a variety of continuous quality improvement interventions including creation of a designated practitioner, this project enhances partnership between patients and health care providers.

Nurses’ Role in the Control and Treatment of Asthma in Adults: A Systematic Literature Review

“…The evidence gathered from the articles analyzed allowed us to identify that nurses play a crucial role in the control and treatment of asthma [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], as there is substantial evidence that supports systematic follow-up or structured consultations on asthma by nurses [ 13 , 14 , 15 , 19 , 25 , 28 ].…”

“…Of the interventions identified in this review, the largest consensus was on the education of individuals with asthma [ 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. In this sense, the following topics that nurses should address in an asthma-related consultation stand out: (i) general information about asthma [ 14 , 28 ], (ii) medication regimen [ 16 , 17 , 19 , 20 , 22 , 23 , 27 , 28 ], (iii) environmental control [ 17 , 18 , 28 ], (iv) prevention and management of exacerbations [ 19 , 21 , 23 , 25 , 28 ], (v) self-management of the disease [ 19 , 20 , 21 , 22 , 25 ], (vi) when to seek out health services [ 22 , 25 ], (vii) understanding the treatment plan [ 19 , 23 ], (viii) breathing exercises [ 16 , 23 ], (ix) use of PEF devices [ 23 , 24 ] and (x) inhalation technique [ 13 , 14 , 15 , 17 , 21 , 23 , 25 , …”

“…It was also found to be useful to involve the family in their care [ 17 , 18 , 23 , 28 ] and/or home visits [ 28 ]. For self-management of the disease by individuals with asthma, it is essential to use written action plans carried out jointly between the health team and the patient [ 14 , 16 , 19 , 21 , 22 , 25 ]. This evidence is in line with what is recommended by the DGH [ 4 ] and by the Global Initiative for Asthma (GINA) [ 5 ].…”

“…Furthermore, only one of the articles analyzed referred to the importance of seasonal influenza vaccination [ 19 ], despite the recommendations of the DGH [ 4 ] and GINA [ 5 ] regarding this vaccine for people with asthma, as well as several other studies [ 37 , 38 ].…”

“…In addition to the surveillance consultation, nurses also play an important role in the management of asthma-related emergencies [ 20 , 23 ]. In this sense, the following interventions, which should be performed by nurses in consultations for acute illnesses related to asthma complications, were identified: (i) assessment of vital signs [ 17 , 20 , 23 ], (ii) evaluation of PEF [ 13 , 14 , 17 , 20 , 23 , 24 ], (iii) oxygen administration [ 23 ], (iv) administration of medication prescribed by the physician [ 20 , 23 ], and (v) patient education on crisis management and relapse prevention [ 19 , 20 , 21 , 22 , 23 , 25 , 28 ].…”