What is believed to be the first quality improvement initiative focusing exclusively on asthmatic teenagers – conducted by researchers at Cincinnati Children’s Hospital Medical Center in Ohio – has reported significant improvements in asthma outcomes.
Asthma is the most common chronic disease in childhood, affecting 9% of all children (approximately 7 million children in total) in the US. Statistics suggest that 10.5 million school days are missed each year due to asthma.
There is no cure for asthma, and severe asthma attacks can be fatal, so it is important for people with asthma to take an active role in managing their condition.
Self-management involves avoiding anything that triggers asthma, without that impeding on the patient’s ability to stay physically active. People with asthma also need to work with their doctor to find medication that works for them and to treat any other conditions that could make their asthma worse.
In 2013, Medical News Today reported on a study published in the Annals of Allergy, Asthma & Immunology demonstrating five areas of quality of life that children and teenagers need to discuss with their parents and health care providers in order to successfully control their asthma. These include whether their asthma is stopping them from physical activity or from going to school, or whether their asthma is worse at home or outside.
Dr. Maria Britto, senior author of the new study and director of the Center for Innovation in Chronic Disease Care at Cincinnati Children’s, says: “Improving asthma is particularly difficult for teenagers, whose adherence to treatment is often poor and outcomes worse than those of younger patients.”
Between 2007 and 2011, Dr. Britto and her colleagues trialled their new quality improvement initiative with 322 teenage primary care asthma patients, of which only 10% had well-controlled asthma.
The patients involved in the trial were given an evidence-based “care bundle of tools” for controlling their asthma. This bundle included controller medications and a plan for setting goals and learning how to overcome barriers.
Nearly all of the patients also received tools for self-management, which included self-assessment and personalized action plans.
From August 2009 onwards, the percentage of patients taking part in the initiative whose asthma was well-controlled increased to and remained at a level of 30%.
The study – published in the journal Pediatrics – also found that the percentage of patients who felt confident in their self-management ability increased from 70% to 85%.
“We were able to achieve sustained improvement in patients whose chronic asthma is not well-controlled by implementing a package of chronic care interventions,” Dr. Britto says.
“These included standardized and evidence-based care; self-management support, such as self-monitoring by using diaries and journals; care coordination and active outreach among health care providers; linking these teens to community resources; and following-up with patients whose chronic asthma is not well-controlled.”
It is not just missed school days that are a problem for asthmatic teenagers. In the US, 640,000 emergency visits and 157,000 hospitalizations occur as a result of childhood asthma each year.
The researchers believe that their study is significant in showing that supported self-management programs are successful in preventing such hospitalizations, though Dr. Britto acknowledges that patients with chronically poor asthma control are still likely to need additional interventions.
Prior to Dr. Britto and her team establishing this initiative, the teenagers in the study had no experience of formally supported self-management, and only 38% had previously been issued with action plans.