Showing posts with label asthma. Show all posts
Showing posts with label asthma. Show all posts

Friday, May 8, 2015

The Pharmacy as a Measure of the Health of Asthmatics in the Community: A New Metric Worth Considering

By: Lewis First, MD, MS; Editor-in-Chief    

          We are always looking for ways to improve the health of populations and the population of asthmatics in a given community can certainly vary in their utilization of health care resources (ranging from routine visits to exacerbations requiring usage of emergency or inpatient resources).  Wouldn’t it be helpful to have a measure that might indicate if the patients with asthma in your community are at risk for getting worse so you might intervene sooner than later to make sure they are complying with their asthma action plans?   Beck et al. (doi: 10.1542/peds.2014-3796) share with us this week in an early-released study how medication data from a chain of pharmacies in one county can determine a higher or lower utilization rate of emergency visits and inpatient admissions.  The authors define the “Pharmacy-level Asthma Medication Ratio (Ph-AMR) as the number of controller fills divided by the number of controller and rescue fills.  The higher the ratio, the more the controller is being utilized relative to rescue medications.  The outcome measure associated with the use of the ratio was the number of emergency visits and admissions divided by the number of asthmatic children in that county served by the 27 pharmacies it contained.   The authors did their best to control for confounders like poverty status and access to care. 
As to results, every 0.1 increase in the ratio resulted in a proportional decrease in emergency visits and hospitalizations.  This is a unique way to think about monitoring the health of the population and may prompt you to share the results with your neighborhood pharmacist to see if they can provide a similar metric on a periodic basis to you so that increased utilization might be curtailed with targeted interventions for those areas of your community served by pharmacies with lower Ph-AMR ratios.  To help you make sense of the importance of thinking about the health of populations and not just individual patients with asthma, check out the commentary written by Dr. Louis Vernacchio (doi: 10.1542/peds.2015-0809) who provides an interesting perspective on the implications of this study.  You’ll breathe easier thinking about ways to improve the monitoring of asthmatics in your community if you read this study and consider forming stronger interprofessional ties with the pharmacies you most rely upon to help insure the health of the population you serve.

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Wednesday, March 18, 2015

To Air Is Human: New Tools In At Home Asthma Treatment

By: Kathleen Walsh  MD, MS; Editorial Board Memeber
      When I ask my adolescent daughter about her asthma care goals, she replies “I don’t have any,” with a sarcastic tone and a charming, braces-filled grin.  However, I know her goals include placing well in cross country races, passing her taekwondo tests, and getting good grades in school.
       All of these require excellent control of her asthma.  When she was a baby, my goals for her asthma were to minimize exacerbation frequency and duration both for her happiness and so I could finish residency.  While achieving my goals for my daughter’s asthma care has always been my primary motivation for adhering to her treatment, only recently have our goals become a part of our discussions with her clinicians.
       In this week’s Pediatrics, the MyAsthma intervention described by Fiks et al. (doi: 10.1542/peds.2014-3167) takes an important early step toward parent and physician shared decision making regarding asthma treatment at home.  MyAsthma is a portal-based intervention, where parents enter information about their child’s asthma, including their goals and their child’s current symptoms, several times a month.  The portal uses evidence-based protocols to support decisions by the family and clinician about when they need to communicate further and when to change the home treatment plan.
      Although the study was relatively small, with twenty-six children in the treatment arm and a 57% participation rate, the authors found statistically significant improvements in some outcomes.  Specifically, children in the treatment group had significantly larger improvements in ACT scores over the study period compared to controls.  In addition, parents in the treatment group reported significantly less missed work than controls.  While other portal-based asthma interventions exist, this is the first to ask parents about their asthma management goals.
      The identification of family care goals is a key step in the parent and clinician co-management of chronic disease.  The portal-based intervention described by Fiks provides decision support for asthma management when and where the patient needs it- at the family’s convenience and at home.  It also enables a partnership between families and clinicians through goal setting, enhanced communication, and early identification and mitigation of changes in health status.  The spread of promising interventions such as this one will provide the necessary support so that families and clinicians can collaborate to improve chronic disease outcomes.  For pediatricians, this is the kind of collaborative care we would like to provide to all of our patients and their families.  

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Monday, September 22, 2014

Two Pertussis Vaccine Studies Shed More Light on Benefits vs. Risks

By: Lewis First, MD, MS; Editor-in-Chief 
Photo via the National Institute for Health

It seems that no matter how many studies we publish on the advantages of vaccinating children against pertussis with the Tdap vaccine, some families ask for even more evidence—so this week, we provide two studies to add to the published benefits of this vaccine.

The first by Quinn et al. (doi:10.1542/peds.2014-1105) focuses on the benefits of “cocooning”, the process of vaccinating close adult contacts of newborn infants against pertussis during a pertussis epidemic in Australia. This was especially effective if parents were vaccinated pre-pregnancy.

The second by Vogt et al. (doi:10.1542/peds.2014-0723) debunks the belief that pertussis immunization in infancy may increase the chances of developing asthma by adolescence as measured by asthma medication use in adolescence. Again, the data convincingly shows no association between pertussis vaccine administered in 1993-1994 and asthma medication prescribed for the study cohort of more than 80,000 children 2008-2010.

If you are looking for two nice studies to further provide vaccine-hesitant parents of your patients with added reassurance that their infant should receive this important vaccine (and parents should get a booster if they haven’t gotten one recently), then take a deep breath. The findings these two studies cough up should help you make your case.

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Thursday, September 11, 2014

Do Your Food Allergic Patients Have Health Management Plans at School?

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by US Dept. of Agriculture
With the increasing prevalence of asthma and food allergies in our patients nowadays, the need for a health management plan in school is critical to insure their health and well-being. Yet how good are our schools at making sure health management plans are in place for asthma and food allergic patients? A new study we published this week is itching to tell you more.

Gupta et al. (doi:10.1542/peds.2014-0402) share with us the results of some demographic and health data from the Chicago Public School database. The results are disappointing and indicate only one in four students has an asthma action plan, and about 50 percent of students with food allergy had school management plans. Just who are the students with and without plans, and why are so few getting these plans instituted in schools are topics included in the Results and Discussion sections of this interesting paper.

Read it in detail and learn more so you can insure that your patients do have asthma and food allergy action plans in place as we enter a new school year.

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Tuesday, August 26, 2014

Asthma, Eczema & Allergic Rhinitis from Pre-, Postnatal Second Hand Smoke Exposure?

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by Javier Ignacio Acuna Ditzel

We certainly suspect an association exists between second-hand smoke exposure and allergic disease, but has it ever been confirmed in peer-reviewed scientific literature? Not as well as Thacher et al. (doi: 10.1542/peds.2014-0427) have done in an early release article we are sharing this week.

Their study involved more than 4,000 children followed for 16 years prospectively, while information was gathered on parental smoking habits, and symptoms of asthma, eczema and allergic rhinitis.

The results are fascinating and itching for your perusal. For example, second-hand smoke exposure in infancy seems to result in increased risk for asthma and allergic rhinitis, while exposure later in life seems to increase the risk of eczema.

These findings just scratch the surface of what awaits your own review of this study—so read on and learn more!

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Friday, June 20, 2014

Maintaining Certification and Attaining Quality Care

Deputy Editor Dr. Alex Kemper offers a preview of a Quality Report being early released this week from our July issue:

By: Alex Kemper, MD, MPH, MS

Photo by COD Newsroom via Flickr
The American Board of Pediatrics has made participating in quality-improvement activities a centerpiece of the maintenance-of-certification (MOC) process. This has been a good strategy to make otherwise busy clinicians aware of the “quality movement” and some of the steps necessary to improve care in their own practice. But, does it make a difference in the delivery of care?

Dr. Vernacchio and colleagues (doi: 10.1542/peds.2013-2643) share with us their experience in implementing an asthma project that could also provide credit for MOC. Three cohorts of pediatricians participated and nearly all received MOC credit, and more importantly, along the way, processes of care improved.

Let us know about your experience in getting Part 4 MOC credit! What did you learn? Would this learning collaborative approach work for your institution? Let us know. Leave a comment below, submit an eLetter through our journal site, or join in the conversation on Facebook or Twitter.

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Monday, June 16, 2014

Decreasing Asthma Readmissions

Deputy Editor Dr. Alex Kemper offers a preview of a Quality Report being early released this week from our July issue:

By: Alex Kemper, MD, MPH, MS

Photo by Hey Paul Studios via Flickr
There is a cacophony of asthma quality measures: Children’s Asthma Care (CAC) -1, CAC-2, CAC-3. CAC-1 and CAC-2 address medication use. CAC-3 is based on the completion of a home management care plan and requires post-discharge follow-up care coordination. Not surprisingly, CAC-3 is the most challenging of the measures. How can a hospital achieve high marks on these measures? Does it make a difference?

Dr. Bergert and colleagues (doi: 10.1542/ peds.2013-1406) share with us their experience. They assembled a multidisciplinary asthma task force to develop interventions and measured the outcomes. Their findings will make you breathe easier about the value of the CAC measures!

What does this inspire you to do for your patients? Let us know by leaving us a comment below or via eLetter on our journal site, or you can weigh in on Facebook or Twitter.

Monday, February 10, 2014

Dexamethasone versus Prednisone for Acute Asthma: Does It Work?

We are so used to using a 5-day course of prednisone for acute asthma exacerbations—but what about giving just one or two doses of dexamethasone?

Photo by Cea via Flickr
Keeney et al. (doi: 10.1542/peds.2013-2273) decided to gather the evidence for or against this therapeutic strategy and share their findings in a meta-analysis being early released this week. While the numbers of randomized controlled trials in the emergency department used for this meta-analysis are smaller than some might hope, the effectiveness of this medication compared to prednisone or prednisolone appears to be quite comparable.

Have you ever tried dexamethasone instead of a 5-day course of prednisone? Does it work? Would you try it after reading this article? Share your comments and thoughts by responding to this blog or on Facebook or Twitter. You may also consider leaving an eLetter on our journal site so you can share some inspiring thoughts on this topic. Take a deep breath and read this study that may change how you handle acute asthma management.

Related Reading:

Wednesday, January 29, 2014

Improving Asthma Care for At-Risk Teens

Deputy Editor Dr. Alex Kemper offers a preview of a Quality Report being early released this week from our February issue:

Public Domain Photo via Wikimedia Commons
We all know that asthma is a common chronic illness that affects an estimated 7 million U.S. children. We also know that there are many adolescents, especially at-risk teens living in cities, whose asthma, despite our best efforts, is under poor control. From previous research, we know that by engaging adolescents to participate in self-management and coordinating community health resources, outcomes can be significantly improved. Is that possible in the “real world”?

Read the Quality Report by Dr. Britto and colleagues (doi: 10.1542/ peds.2013-0684) to find out! They implemented interventions for their patients guided by the Chronic Care Model focused on standardized and evidence-based care in an approach that emphasized care coordination and active outreach, self-management support, and community connections.

Could you replicate this in your community? Are the resources available? What would need to change? Participate in the conversation by leaving your comment below, on Facebook or via Twitter, or submit an eLetter to the authors at our website.

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