Category Archives: Asthma : Part 3

Understanding of Asthma Management: Adolescence

Understanding of Asthma Management: AdolescenceParents viewed their medical provider as their main source for asthma education. Some caregivers believed they needed asthma education beyond that provided by their physician, while others believed the physician and staff were in greater need of the asthma education. Several caregivers were very satisfied with the level of support and coordination of asthma care in the physician’s office. Successful medical provider approaches were multidisciplinary, including a physician staff team approach to the delivery of asthma care and education. so
As “she got older she came to me, she said ‘Mom, I’m tired of taking all this medicine. It’s nasty, I’m just tired’. And we went through a phase where she was half taking her medications.” An unanticipated issue that surfaced from parents was the need for support and age-appropriate asthma education for teenaged children. Caregivers reported a change in their ability to properly manage their child’s asthma during this transition from adolescent to teen. In younger children, parents were better able to oversee activities, adhere to medication schedules, and avoid exposure to environmental triggers. We found that with teenage children the impact of peer pressure and the need for belonging was not only evident but directly impacted the child’s adherence to their asthma management. The feelings of invincibility and embarrassment experienced by teenagers toward their asthma care routines were difficult for parent’s to penetrate even when the child fully comprehended the severity of their disease.
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Understanding of Asthma Management: Role of Medical Provider

Caregivers expressed a concern that care provided differed when physicians or medical staff noted their Medicaid insurance coverage. Some had to show extra paperwork at the physician’s office, while others believed they received lesser treatment or were stigmatized. Overall, parents believed that coverage provided by Medicaid was adequate and that the needed care was available for their child. Medicaid was credited by some parents as allowing them to establish a medical home for their child’s asthma care.
Caregivers of children with asthma were concerned with the level of access to medical providers during an asthma episode. Availability of 24-h call lines during an emergency were seen as strategies to receive support prior to visiting an emergency department. Parents were concerned the level of office triage for asthma was either missing or of a lower priority, specifically during an asthma episode. Again, perceptions of discrimination and indifference were mentioned as issues for parents of children receiving care insured by Medicaid: “Or you are not going to get the full care that you would if you had regular insurance.”
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Understanding of Asthma Management: Medicaid Health-Care System

Understanding of Asthma Management: Medicaid Health-Care SystemCaregivers addressed the impact of their child’s asthma on their employment. Parents expressed the need for care throughout the day, knowing that they were unable to monitor their child 24 h/d. Appropriate management strategies for monitoring of their child’s asthma, including peak flow readings, were utilized by some parents in adjusting medications as needed in the mornings and evenings to avoid problems during the work day.
Experiences with the Medicaid system and personnel varied, while some caregivers mentioned no complaints, others believed they were discriminated against or frustrated by paperwork and changing coverage. Physician or specialist referrals were cited by parents as a barrier to acquiring proper asthma care. An additional barrier to ensuring good asthma care for children was the limitations set on refills by insurance. Caregivers believed it would be easier to manage their child’s asthma if they were able to receive multiple inhalers: one for school and another for home. Likewise, they need to be allowed to refill medications that were lost prior to the Medicaid 30-day refill cycle. read
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Understanding of Asthma Management: School/Daycare Support and Work

Although parents have learned methods to diminish the effects of environmental triggers, they continued to experience situations that were beyond their control. These included exposures at friends’ or relatives homes.
“We couldn’t even go to restaurants because they have part of it [where] you smoke [and] one part you can’t. So no matter what, if you’re in there… smoke is in the environment and the child gets sick. And [if] you complain about it, well it’s not a smoke-free environment.” Smoke-free restaurants and public locations continue to be a challenge for parents of children with asthma. Many believed community education of environmental triggers of asthma would assist in eliminating exposure and improving the family and child’s quality of life.
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Understanding of Asthma Management: Caregiver/Patient Knowledge

Understanding of Asthma Management: Caregiver/Patient KnowledgeOthers remained stressed or overwhelmed by their child’s asthma: “I get nervous, I’m still not used to it, so I run to the doctor a lot. I don’t know if I’m giving too much medicine, the right medicine. You know, sometimes they treat me like I ought to know but I don’t know!” further
Unfortunately, some parents did not have asthma management plans, which provided them less support to deal with their child’s illness and their fears. Some parents expressed low self-efficacy in execution of management strategies needed to treat their child’s symptoms. The caregiver’s emotions appeared to play an important role in the delivery of asthma care but could be positively affected by a supportive relationship with the medical provider.
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Understanding of Asthma Management: Results

Four focus groups were held between December 2001 and January of 2002, including 35 women and 1 man. Primary care providers were self-identified as the biological mother (89%) and were most commonly in the age range of 25 to 35 years (50%). The majority of participants were African Americans (64%), and 31% were married. Participants reported an annual income range of < $10,000, with only five participants with an income > $30,000/yr. The median level of education for the participants was 13 years. The children of the focus group members had a median age of 10 years. Forty-seven percent experienced frequent daytime asthma symptoms occurring daily or several times a week. Children missed a median of 8 days of school during the first half of the current academic year. Only four caregivers reported an asthma specialist managed their child’s asthma. All children were prescribed some asthma-related medication. Ninety-seven percent received an inhaled (3-agonist. Fifty percent reported taking a leukotriene inhibitor, and 47% reported inhaling corticosteroids. Almost one third reported taking oral steroids within the last year.
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Understanding of Asthma Management: Analysis

Understanding of Asthma Management: AnalysisThe research team, including a pediatric pulmonologist and a respiratory therapist asthma educator, developed 13 prepared questions and prompts. The questions were based on a review of the literature with a focus on health goals, asthma care including environmental factors, medications, school support, family support, and issues relating to access to medical care. A content review of the questions was conducted by a pulmonologist and two pediatricians.
The focus group sessions were lead by two experienced facilitators (associated with the University of Michigan) who were present for all discussions applying a format outlined by Krueger. The groups were conducted in a manner to ensure anonymity, minimize group pressure, and encourage honest and spontaneous discussion. The moderators listened carefully to the participants and sought clarification of verbal and nonverbal responses, and asked participants to verify summarizing comments. Follow-up probe questions were asked to encourage and maintain discussion of topics. The moderators discussed and summarized each group discussion immediately after the gathering.
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Understanding of Asthma Management: Materials and Methods

The participants were a convenience sample of 36 parental caretakers of 6- to 16-year-old children with (1) an asthma diagnosis, and (2) currently or previously enrolled in the Michigan Medicaid Health Management Organization/System. Eligibility was limited to parents or legal guardians of children 6 to 16 years of age with persistent asthma. Persistent disease was categorized using the National Asthma Education and Prevention Program asthma diagnosis and care guidelines and was defined as follows: asthma symptoms at least every other day during a 1-month period, > 2 nights of sleep interrupted in a month, daily asthma medications for at least 30 consecutive days, or 5 days of missed school due to asthma symptoms. The University of Michigan Institutional Review Board approved the study prior to identification and enrollment of study participants.
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Understanding of Asthma Management

Understanding of Asthma ManagementAsthma is the most common chronic disease of childhood, and asthma prevalence in Michigan is higher than the national average. Strategies to alleviate the burden of asthma include health-care provider education and training to improve the use of clinical guidelines for asthma management and to improve health-care provider skills regarding asthma patient education, especially among high-risk patients.
As part of the development of an educational program for physicians targeted to high-risk asthma patients, we conducted focus group sessions among parents of Medicaid-insured children with persistent asthma. It was important to include the perspective of this group on asthma care because asthma is more prevalent among economically disadvantaged children and they have high risk of hospital admission for asthma. sildenafil citrate pink

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Outcomes of a Web-Based Patient Education Program for Asthmatic Children and Adolescents: Recommendation

Outcomes of a Web-Based Patient Education Program for Asthmatic Children and Adolescents: RecommendationIn this context, it is remarkable that drug costs in the intervention groups decreased significantly, although past queries have shown the opposite phenomenon in the aftermath of educational activities. Obviously, there is no backlog demand in the investigated population, and better compliance has given leeway to dose reductions, at least in the intervention groups.
Another hint at a relatively good asthma control in the pre-run to the current survey is the small number of hospitalizations recorded for study participants. In contrast to population-based surveys in which hospitalization costs make up between 53% and 72% of all direct costs, the initial range of 3% (IEP group) to 7% (SPMP group) in our study documents the potential selection bias of well-controlled asthmatics when compared to the average.
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