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Impact of a diagnostic therapeutic educational pathway program for asthma management in preschool children
Sebastiano Guarnaccia1, Cristina Quecchia2, Andrea Festa3
1Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. guarnaccia.s@gmail.com.
Insights
The Diagnostic Therapeutic Educational Pathway (DTEP) program improved wheezing control in preschool children with asthma. This asthma management approach reduced emergency visits and healthcare resource utilization in young children.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Clinical Pathway Implementation
Background:
- Preschool children with asthma incur high healthcare costs due to frequent emergency visits.
- No prior clinical trials evaluated combined diagnostic, therapeutic, and educational pathways for wheezing control in children under 6.
- This study assesses a pediatric program for asthma management in young children.
Purpose of the Study:
- To evaluate the impact of the Diagnostic Therapeutic Educational Pathway (DTEP) program on asthma management in children under 6 years old.
- To assess changes in healthcare resource utilization and symptom control following DTEP implementation.
- To analyze the effectiveness of an integrated approach for pediatric asthma care.
Main Methods:
- Retrospective population-based cohort study of 741 children (0-5 years) with asthma.
- Evaluation of hospitalization, emergency room visits, outpatient services, and drug usage rates before and after DTEP intervention.
- Analysis of wheezing symptom control improvement across DTEP visits.
Main Results:
- Significant decrease in hospitalization, emergency visits, and outpatient service utilization ( -8.6% to -80.4%).
- Improved wheezing symptom control observed, with percentages increasing from 39.5% to 60.9% (0-2 years) and 25.5% to 75.5% (3-5 years).
- Declines in specific drug prescriptions (LABA, antibiotics, systemic corticosteroids) but increases in SABA, inhaled corticosteroids, and leukotriene receptor antagonists.
Conclusions:
- The integrated DTEP program demonstrates improved wheezing control in preschool children with asthma.
- The DTEP approach led to a reduction in adverse therapeutic-related outcomes.
- Real-world evidence supports the effectiveness of this pediatric asthma management pathway.
Background:
Preschool children with clinically-diagnosed asthma have a higher rate of emergency department visits and consume more resources for management than older children. However, no clinical trials have yet been performed measuring the impact of a combined diagnostic, therapeutic and educational pathway regimen for evaluation of wheezing control in children aged less than 6 years. The purpose of the present study was to assess the impact of a pediatric program developed in Italy, the Diagnostic Therapeutic Educational Pathway (DTEP), for asthma management in children less than 6 years old attending an asthma referral center.
Methods:
This is a retrospective population-based cohort study performed in children with asthma aged 0-5 years, attending at "Io e l'Asma center", Brescia, Italy between September 2007 and December 2014. The incidence rates (IRs) of hospitalization, emergency room visits, use of outpatient services and drug usage for dyspnea, wheezing, or respiratory symptoms were evaluated for time periods prior to and after DTEP intervention.
Results:
A total of 741 patients, aged 0-5 years completed the DTEP, including 391 and 350 children aged 0-2 and 3-5 years, respectively. The percentage of children aged 0-2 and 3-5 years showing improved control of wheezing symptoms during the 1st to 3rd visit interval as a result of the DTEP intervention increased from 39.5 to 60.9% and from 25.5 to 75.5%, respectively. During these periods, the IRs showed a significant decrease for all outcomes, from-8.6% to - 80.4%. Although specific IRs for drug prescriptions declined, particularly for LABA plus corticosteroids, antibiotics, and systemic corticosteroids, they increased for SABA, inhaled corticosteroid and leukotriene receptor antagonist usage.
Conclusions:
The results suggest that a real-world assessment of the integrated DTEP program for preschool children provides evidence for improved wheezing control and reduction of adverse therapeutic related outcomes.
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