Strategies for Improving Patient Outcomes in Pediatric Asthma Through Education. Pediatric Asthma. Epidemiology. Epidemiology

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1 Strategies for Improving Patient Outcomes in Pediatric Asthma Through Education Chris Orelup, MS3 Max Project 3/1/01 Pediatric Asthma The leading cause of illness in childhood 10, 000, 000 school absences per year The most frequent admitting diagnosis in childhood 3,028,000 visits to PCP 570,000 Emergency Department Visits 164,000 Hospitalizations Onset Can be at any age 30% by age % by age 4-5 Epidemiology Epidemiology Prevalence Overall in US is ~ 5% Increasing worldwide Double in boys (prior to puberty) Disproportionately increased in cities Disparity is increasing Higher reliance on acute, episodic care Connecticut 59,000 children with asthma

2 Epidemiology Risk Factors Poverty Urban home? Race Maternal age < 20 at birth of child Low birthweight Epidemiology Risk Factors (continued) Small home size Large family size Maternal smoking Increased allergen exposure Obesity Eczema Allergies Pathophysiology Pathophysiology Inflammatory Process Bronchoconstriction Bronchial smooth muscle hypertrophy Mucus gland hypertrophy

3 NHLBI Guidelines National Heart, Lung, and Blood Institute Division of NIH 1997 Consensus report on diagnosis and management of asthma Revision of original 1991 statement Current standard of care Diagnosis Recurrent coughing or wheezing Exacerbated by triggers Wheezing may be absent Reversible airway obstruction Improvement with inhaled albuterol Spirometry Management Pharmacologic Albuterol PRN Inhaled anti-inflammatory agents for persistent disease Cromolyn, nedocromil, steroids Other agents Encourage spacer use Management Education Proper medication use Self-monitoring of symptoms Peak flow Written action plan School plans Environmental Avoidance and reduction of triggers Prompt communication with clinician

4 Compliance Are the NHLBI Recommendations Followed?? Compliance Are the NHLBI Recommendations Followed?? NO!!!

5 Compliance Warman et al Examined real practices vs. guidelines Written action plan Peak flow meter use Albuterol use Anti-inflammatory use (if needed) Prompt contact with clinician Compliance Warman et al Results 97 % used Albuterol 34 % had action plans 30 % used peak flow meter regularly 39 % of asthmatics who needed anti-inflammatory medications were using them Many environmental triggers present Impact on Kids Klinnert et al Examined emotional adjustment of pediatric asthma patients Increased anxiety levels Poor emotional regulation Directly related to severity of symptoms Education Clear need for asthma education Patients Parents Forms of education Asthma Clinics Asthma Outreach Programs School Based Parent Education Clincal Care

6 Local Outreach Programs American Lung Association of CT Allergy and Asthma Federation of America New England Chapter A Is For Asthma Developed by ALA and CTW Aimed at preschoolers Set in context of Sesame Street New character Dani General Information What to do if friend has an attack Open Airways For Schools School Based, Ages 8-11 Developed at Columbia 6 lessons, 40 minutes each Stories Games Role playing Teaches causes and management of asthma Proven track record

7 Tools for Schools Low cost assessment of indoor air quality Checklists Facts Problem solving tool Sources of indoor pollution Outdoor Activities Camp Treasure Chest Ages 9-13 Weeklong overnight summer camp Traditional camp activities along with asthma education Medical supervised Breath Games Olympic style event, Ages 6-15 Patient and parent education CT Asthma Info Center Free Information Referral Services Speakers Bureau Healthcare Provider Education AAFA Day Care Provider Education Asthma Checklist On Site Training (3 hour session) Adolescent Education Power Breathing program for teens School Nurse Advocacy

8 Outcomes Does asthma education work?? Outcomes Does asthma education work?? YES!!! Outcomes Does asthma education work?? YES!!! Education leads to: Decreased patient morbidity Decreased acute care utilization Decreased overall costs Outcomes Christiansen et al Inner-city, minority 4th graders NHLBI Guidelines Increased asthma disease awareness Improved inhaler / peak flow meter technique Significantly lower symptoms at 6 months

9 Outcomes / Costs Greineder et al Ages 1-15 Asthma Outreach Program Decreased ED visits 57 % Decreased hospitalizations by 75% Decreased expenditures by 72% Cost savings of $11.67 for every dollar spent Outcomes / Costs Kelley et al Ages 2-16 with Hx of frequent urgent care use AOP using NHLBI guidelines Decreased PCP, ED, hospital visits Decreased yearly per child health care expenditures by $543 versus control Outcomes / Costs Net Result = Education Works Improved Outcomes Decreased resource utilization Decreased costs Future?? Broader Implementation of Asthma Outreach Programs Patient School Based Education Close clinical intervention Caregiver Education Access to information

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