Written Action Plan in Pediatric Emergency Room Improves Asthma Prescribing, Adherence, and Control

被引:125
作者
Ducharme, Francine M. [1 ,2 ,3 ]
Zemek, Roger L. [4 ]
Chalut, Dominic [5 ]
McGillivray, David [5 ]
Noya, Francisco J. D. [5 ]
Resendes, Sandy [1 ]
Khomenko, Lyudmyla [1 ]
Rouleaus, Rachel [5 ]
Zhang, Xun [6 ]
机构
[1] CHU St Justine, Res Ctr, Dept Pediat, Appl Clin Res Unit, Montreal, PQ H3T 1CS, Canada
[2] Univ Montreal, Dept Pediat, Montreal, PQ H3C 3J7, Canada
[3] McGill Univ, Dept Epidemiol Biostat & Occupat Hlth, Montreal, PQ, Canada
[4] Univ Ottawa, Dept Pediat, Childrens Hosp Eastern Ontario, Ottawa, ON K1N 6N5, Canada
[5] Montreal Childrens Hosp, Dept Pediat, Montreal, PQ H3H 1P3, Canada
[6] McGill Univ, Ctr Hlth, Res Inst, Montreal, PQ, Canada
关键词
asthma; child; drug prescribing; medication adherence; patient discharge; RANDOMIZED CONTROLLED-TRIAL; QUALITY-OF-LIFE; FOLLOW-UP; INHALED CORTICOSTEROIDS; DEPARTMENT VISIT; YOUNG-CHILDREN; INNER-CITY; HIGH-RISK; MANAGEMENT; CARE;
D O I
10.1164/rccm.201001-0115OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: An acute-care visit for asthma often signals a management failure. Although a written action plan is effective when combined with self-management education and regular medical review, its independent value remains controversial. Objectives: We examined the efficacy of providing a written action plan coupled with a prescription (WAP-P) to improve adherence to medications and other recommendations in a busy emergency department. Methods: We randomized 219 children aged 1-17 years to receive WAP-P (n = 109) or unformatted prescription (UP) (n = 110). All received fluticasone and albuterol inhalers, fitted with dose counters, to use at the discretion of the emergency physician. The main outcome was adherence to fluticasone (use/prescribed X 100%) over 28 days. Secondary outcomes included pharmacy dispensation of oral corticosteroids, beta(2)-agonist use, medical follow-up, asthma education, acute-care visits, and control. Measurements and Main Results: Although both groups showed a similar drop in adherence in the initial 14 days, adherence to fluticasone was significantly higher over Days 15-28 in children receiving WAP-P (mean group difference, 16.13% [2.09, 29.91]). More WAP-P than UP patients filled their oral corticosteroid prescription (relative risk, 1.31 [1.07, 1.60]) and were well-controlled at 28 days (1.39 [1.04, 1.86]). Compared with UP, use of WAP-P increased physicians' prescription of maintenance fluticasone (2.47 [1.53, 3.99]) and recommendation for medical follow-up (1.87 [1.48, 2.35]), without group differences in other outcomes. Conclusions: Provision of a written action plan significantly increased patient adherence to inhaled and oral corticosteroids and asthma control and physicians' recommendation for maintenance fluticasone and medical follow-up, supporting its independent value in the acute-care setting.
引用
收藏
页码:195 / 203
页数:9
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