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Delivering tailored asthma family education in a pediatric emergency department setting: a pilot study
Marianna M Sockrider1, Stuart Abramson, Edward Brooks
1Department of Pediatrics, Baylor College of Medicine, 6621 Fannin, MC 1040.00, Houston, Texas 77030, USA. mmsockrider@texaschildrenshospital.org
Insights
A tailored asthma self-management intervention in the pediatric emergency department (ED) improved caregiver confidence and well-asthma visits. This approach may reduce costly emergency asthma care for children.
Area of Science:
- Pediatric Emergency Medicine
- Asthma Self-Management
- Health Intervention Studies
Background:
- Acute asthma exacerbations frequently lead to pediatric emergency department (ED) visits, incurring significant healthcare costs.
- Many families lack written asthma action plans and essential self-management skills, contributing to preventable ED utilization.
- Effective interventions are needed to empower families in managing childhood asthma and reduce emergency care reliance.
Purpose of the Study:
- To evaluate a tailored asthma self-management intervention delivered in the ED for families of children with asthma.
- To assess the intervention's impact on caregiver confidence in asthma management 14 days postintervention.
- To determine the intervention's effect on well-asthma visits and urgent care/ED visits at 9 and 12 months.
Main Methods:
- A randomized intervention/usual-care study conducted across 4 urban pediatric ED sites.
- Asthma educators utilized a computer-based system to personalize intervention messages, asthma action plans, and educational summaries.
- Children with acute asthma were enrolled during ED visits, with follow-up telephone interviews conducted over 9 months.
Main Results:
- Enrollment of 464 subjects aged 1-18 years, with varying asthma severity classifications.
- Significantly higher caregiver confidence in preventing and managing asthma episodes in the intervention group at 14 days.
- Increased reporting of well-asthma visits by 9 months and reduced return ED visits for children with intermittent asthma in the intervention group.
Conclusions:
- The tailored ED-based self-management intervention positively impacted caregiver confidence and well-visit follow-up rates.
- The intervention shows promise in improving asthma management outcomes for children.
- Further long-term evaluation is necessary to fully ascertain the sustained impact of this intervention.
Objective:
Many children are brought to the pediatric emergency department (ED) with acute asthma symptoms. Emergency asthma care is costly, and many ED visits may be preventable. Families often do not have written asthma action plans and lack asthma self-management skills. This study tests a tailored self-management intervention delivered in the ED for families of children with asthma. The primary hypotheses were that the intervention group would have greater confidence to manage asthma 14 days postintervention and more well-asthma visits and fewer urgent care/ED visits at 9 and 12 months.
Methods:
This randomized intervention/usual-care study was part of a larger ED asthma surveillance project in 4 urban pediatric ED sites. Asthma educators used a computer-based resource to tailor the intervention messages and provide a customized asthma action plan and educational summary. Children with acute asthma were enrolled during an ED visit, and follow-up telephone interviews were conducted during the next 9 months. The ED clinician classified the child's acute and chronic severity.
Results:
To date, 464 subjects aged 1 to 18 years have been enrolled. The ED clinicians reported that 46% had intermittent and 54% had persistent chronic severity with 51% having mild acute severity episodes. The confidence level to prevent asthma episodes and keep them from getting worse was significantly higher in the intervention group at 14 days postintervention. More subjects in the intervention group reported well-asthma visits by 9 months. Return ED visits were significantly lower in the intervention group in those with intermittent asthma. Twelve-month follow-up is in process.
Conclusions:
The tailored ED self-management intervention demonstrates significant effects on caregiver self-confidence and well-visit follow-up. Additional evaluation is needed to determine what impact this intervention has long-term.
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