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An interdisciplinary intervention for undertreated pediatric asthma
Natalie Walders1, Carolyn Kercsmar2, Mark Schluchter2
1National Jewish Medical and Research Center, Denver, CO.
Insights
An interdisciplinary intervention for pediatric asthma did not improve symptoms but reduced emergency care visits. This approach offers a modest benefit for managing childhood asthma effectively.
Area of Science:
- Pediatric Pulmonology
- Healthcare Intervention Studies
- Asthma Management
Background:
- Pediatric asthma is a significant public health concern, often undertreated.
- Lack of written treatment plans and frequent exacerbations characterize severe pediatric asthma cases.
- Effective interventions are needed to reduce healthcare utilization and improve quality of life for children with asthma.
Purpose of the Study:
- To evaluate the effectiveness of an interdisciplinary intervention for pediatric asthma.
- To assess the impact of integrated care, education, and therapy on asthma outcomes.
- To determine if the intervention reduces asthma-related healthcare utilization and improves quality of life.
Main Methods:
- A randomized, controlled study was conducted at an urban tertiary-referral pediatric hospital.
- 175 pediatric patients with uncontrolled asthma were randomized to either standard medical care or an interdisciplinary intervention.
- The intervention included medical care, asthma education, problem-solving therapy, and a nurse advice line.
Main Results:
- Both groups showed significant improvements in asthma symptoms and quality of life.
- No significant between-group differences were observed in symptom reduction or quality of life.
- The intervention group had significantly lower healthcare utilization, with 28% requiring emergency/inpatient services versus 41% in the control group.
Conclusions:
- The interdisciplinary intervention did not improve asthma symptoms in pediatric patients.
- The intervention demonstrated a modest but significant reduction in the utilization of acute medical care for asthma.
- Integrated care approaches may be beneficial for reducing healthcare burden in pediatric asthma management.
Study Objectives:
To examine the effectiveness of an interdisciplinary intervention for pediatric asthma.
Design:
Randomized, controlled study.
Setting:
Urban tertiary-referral pediatric hospital.
Participants:
One hundred seventy-five patients with asthma lacking written treatment plans and presenting with asthma-related emergency department visits (two or more) and/or hospitalizations (one or more) in the past year were randomized to a comparison group receiving medical care alone (n = 86) or to an interdisciplinary intervention group receiving medical care, asthma education, and problem-solving therapy (n = 89)
Intervention:
All participants received written asthma management plans, peak flow meters, and spacer devices. The intervention group also received asthma education, an asthma risk profile assessment, brief problem-solving therapy, and access to a 24-h nurse advice line. The primary outcome measure was change in asthma symptoms, and secondary outcomes included health-care utilization and asthma-related quality of life.
Results:
Both groups demonstrated significant reductions in asthma symptoms and improvements in quality of life without any between-group differences identified over the course of follow-up. In contrast, the intervention group demonstrated less frequent health-care utilization than the comparison group, with 28% of the intervention group requiring emergency department or inpatient services for asthma compared to 41% of the comparison group (adjusted odds ratio, 1.92; 95% confidence interval, 1.00 to 3.69) over the 12-month follow-up period.
Conclusions:
This study examined the effectiveness of an interdisciplinary intervention for undertreated asthma. The intervention did not result in improvements in asthma symptoms, but accomplished modest reductions in the utilization of acute medical care.
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