Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. S135-S144 (doi:10.1542/peds.2005-2000K)
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SUPPLEMENT ARTICLE

Delivering Tailored Asthma Family Education in a Pediatric Emergency Department Setting: A Pilot Study

Marianna M. Sockrider, MD, DrPHa, Stuart Abramson, MD, PhDa, Edward Brooks, MDb, A. Chantal Caviness, MD, MPHa, Susan Pilney, MBAa, Christine Koerner, MDc and Charles G. Macias, MD, MPHa

a Department of Pediatrics, Baylor College of Medicine, Houston, Texas
b Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
c Department of Pediatrics, University of Texas Health Sciences Center, Houston, Texas

OBJECTIVE. Many children are brought to the pediatric emergency department (ED) with acute asthma symptoms. Emergency asthma care is costly, and many ED visits may be preventable. Families often do not have written asthma action plans and lack asthma self-managment skills. This study tests a tailored self-managment intervention delivered in the ED for families of children with asthma. The primary hypotheses were that the intervention group would have greater confidence to manage asthma 14 days postintervention and more well-asthma visits and fewer urgent care/ED visits at 9 and 12 months.

METHODS. This randomized intervention/usual-care study was part of a larger ED asthma surveillance project in 4 urban pediatric ED sites. Asthma educators used a computer-based resource to tailor the intervention messages and provide a customized asthma action plan and educational summary. Children with acute asthma were enrolled during an ED visit, and follow-up telephone interviews were conducted during the next 9 months. The ED clinician classified the child’s acute and chronic severity.

RESULTS. To date, 464 subjects aged 1 to 18 years have been enrolled. The ED clinicians reported that 46% had intermittent and 54% had persistent chronic severity with 51% having mild acute severity episodes. The confidence level to prevent asthma episodes and keep them from getting worse was significantly higher in the intervention group at 14 days postintervention. More subjects in the intervention group reported well-asthma visits by 9 months. Return ED visits were significantly lower in the intervention group in those with intermittent asthma. Twelve-month follow-up is in process.

CONCLUSIONS. The tailored ED self-management intervention demonstrates significant effects on caregiver self-confidence and well-visit follow-up. Additional evaluation is needed to determine what impact this intervention has long-term.

Key Words: pediatric asthma • self-management • patient education • emergency care

Abbreviations: ED—emergency department • TEDAS—Texas Emergency Department Asthma Surveillance • QoL—quality of life • ITG-CASF—Integrated Therapeutics Group Child Asthma Short Form • OR—odds ratio • CI—confidence interval

Accepted Dec 6, 2005.




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