Keeping children with asthma out of hospitals: Parents' and physicians' perspectives on how pediatric asthma hospitalizations can be prevented

被引:63
作者
Flores, G
Abreu, M
Tomany-Korman, S
Meurer, J
机构
[1] Med Coll Wisconsin, Ctr Advancement Underserved Childre, Dept Pediat, Milwaukee, WI 53226 USA
[2] Med Coll Wisconsin, Sect Gen Pediat, Dept Pediat, Milwaukee, WI 53226 USA
[3] Med Coll Wisconsin, Dept Epidemiol, Milwaukee, WI 53226 USA
[4] Med Coll Wisconsin, Hlth Policy Inst, Milwaukee, WI 53226 USA
[5] Childrens Hosp Wisconsin, Childrens Res Inst, Milwaukee, WI USA
[6] Boston Univ, Sch Publ Hlth, Boston, MA 02215 USA
关键词
asthma; minority groups; hospitalization; children; pediatrics; patient admission; health services research;
D O I
10.1542/peds.2005-0712
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background. A total of 196 000 hospitalizations occur each year among the 9 million US children who have been diagnosed with asthma. Not enough is known about how to prevent pediatric asthma hospitalizations. Objectives. To identify the proportion of preventable pediatric asthma hospitalizations and how such hospitalizations might be prevented, according to parents and physicians of hospitalized children with asthma. Methods. A cross-sectional survey was conducted of parents, primary care physicians (PCPs), and inpatient attending physicians (IAPs) of a consecutive series of all children who were admitted for asthma to an urban hospital in a 14-month period. Results. The 230 hospitalized children had a median age of 5 years; most were poor ( median annual family income: $ 13 356), were nonwhite (93%), and had public (74%) or no (14%) health insurance. Compared with children who were hospitalized for other ambulatory care sensitive conditions, hospitalized children with asthma were significantly more likely to be African American (70% vs 57%), to be older, and not to have made a physician visit or telephone contact before admission (52% vs 41%). Only 26% of parents said that their child's admission was preventable, compared with 38% of PCPs and 43% of IAPs. The proportion of asthma hospitalizations that were assessed as preventable varied according to the source or combination of sources, from 15% for agreement among all 3 sources to 54% as identified by any 1 of the 3 sources. PCPs (83%) and IAPs (67%) significantly more often than parents (44%) cited parent/patient- related reasons for how hospitalizations could have been prevented, including adhering to and refilling medications, better outpatient follow-up, and avoiding known disease triggers. Parents (27%) and IAPs (26%) significantly more often than PCPs (11%) cited physician-related reasons for how hospitalizations could have been avoided, including better education by physicians about the child's condition, and better quality of care. Multivariate analyses revealed that an age >= 11 years and no physician contact before the hospitalization were associated with similar to 2 times the odds of a preventable asthma hospitalization. Conclusions. The proportion of asthma hospitalizations assessed as preventable varies from 15% to 54%, depending on the source. Adolescents and families who fail to contact physicians before hospitalization are at greatest risk for preventable hospitalizations. Many pediatric asthma hospitalizations might be prevented if parents and children were better educated about the child's condition, medications, the need for follow-up care, and the importance of avoiding known disease triggers.
引用
收藏
页码:957 / 965
页数:9
相关论文
共 27 条
[1]   Inadequate use of asthma medication in the United States: Results of the Asthma in America national population survey [J].
Adams, RJ ;
Fuhlbrigge, A ;
Guilbert, T ;
Lozano, P ;
Martinez, F .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2002, 110 (01) :58-64
[2]  
[Anonymous], 2000, HLTH PEOPL 2010, V1
[3]   Relationship of adherence to pediatric asthma morbidity among inner-city children [J].
Bauman, LJ ;
Wright, E ;
Leickly, FE ;
Carin, E ;
Kurszon-Moran, D ;
Wade, SL ;
Visness, CM .
PEDIATRICS, 2002, 110 (01) :e6
[4]   Measurement of children's asthma medication adherence by self report, mother report, canister weight, and Doser CT [J].
Bender, B ;
Wamboldt, FS ;
O'Connor, SL ;
Rand, C ;
Szefler, S ;
Milgrom, H ;
Wamboldt, MZ .
ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY, 2000, 85 (05) :416-421
[5]   Use of inhaled corticosteroids following discharge from an emergency department for an acute exacerbation of asthma [J].
Blais, L ;
Beauchesne, MF .
THORAX, 2004, 59 (11) :943-947
[6]   Parental management of asthma triggers within a child's environment [J].
Cabana, MD ;
Slish, KK ;
Lewis, TC ;
Brown, RW ;
Nan, B ;
Lin, XH ;
Clark, NM .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2004, 114 (02) :352-357
[7]   HOSPITALIZATIONS OF CHILDREN AND ACCESS TO PRIMARY-CARE - A CROSS-NATIONAL COMPARISON [J].
CASANOVA, C ;
STARFIELD, B .
INTERNATIONAL JOURNAL OF HEALTH SERVICES, 1995, 25 (02) :283-294
[8]  
*CHILDH ASTHM MAN, 2000, NEW ENGLAND J MED, V0343
[9]   Home and allergic characteristics of children with asthma in seven US urban communities and design of an environmental intervention: The Inner-City Asthma Study [J].
Crain, EF ;
Walter, M ;
O'Connor, GT ;
Mitchell, H ;
Gruchalla, RS ;
Kattan, M ;
Malindzak, GS ;
Enright, P ;
Evans, R ;
Morgan, W ;
Stout, JW .
ENVIRONMENTAL HEALTH PERSPECTIVES, 2002, 110 (09) :939-945
[10]  
DEY AN, 2004, VITAL HLTH STAT, V510, P1