Change in approach and delivery of medical care in children with asthma: results from a multicenter emergency department educational asthma management program.

OBJECTIVES: The Hawaii Child Asthma Research to Elevate Standards (CARES) Program implemented an emergency department (ED)-based education and management program to facilitate National Asthma Education and Prevention Program (NAEPP) guideline understanding among asthmatic children and their families, ED staff, and health care providers. METHODS: The multipronged approach used: (1) 2-phased prospective tracking system of ED asthma patients; (2) ED-based educational intervention for patients/families; and (3) asthma education for ED staff and community-based health care providers. Data were collected across 4 EDs during phase I (October 8, 2002, to October 1, 2003) and phase II (October 1, 2003, to July 8, 2004). Follow-up data were collected by telephone 3 weeks (phase I), and 3 weeks and 3 months (phase II) after the ED encounter. The patient/family intervention was delivered throughout phase II. During phase I, ED and community-based health care professionals developed strategies for building an integrated asthma care system. ED staff training was delivered before phase II. Continuing medical education for health care providers was delivered before and during the first month of phase II. RESULTS: Tracking data on 706 phase I and 353 phase II patient encounters revealed that the majority of patients with persistent asthma did not use long-term controller medications and did not possess a written asthma action plan. From preintervention to postintervention, the number of patients possessing a written asthma action plan increased from 48 to 322. Of 186 persistent asthmatics, 34 were using controller medications daily, 34 as needed, and 118 not at all. Daily use increased to 80 3 weeks postintervention and to 68 3 months postintervention. CONCLUSION: An ED-based childhood asthma tracking system can serve as a basis for designing and implementing an ED-based educational intervention. ED staff, primary care providers, and others can work together to promote asthma care.

Evaluation of secondhand smoking characteristics in asthmatic children presenting to four emergency departments on O'ahu, Hawai'i.

Exposure to secondhand smoke causes adverse health outcomes particularly in vulnerable groups like children. This multi-centered prospective study examined the household exposure to secondhand smoke among asthmatic children presenting to emergency departments on O'ahu, Hawai'i. Findings revealed that asthmatic children of Samoan, Micronesian, Filipino, Part/Native Hawaiian and Other/Mixed Ancestry had a greater proportion of high exposure to secondhand smoke in the home compared to Japanese, Chinese and Caucasian ethnic groups. Asthmatic children with no insurance or with Medicaid had a greater frequency of high exposure to secondhand smoke in the home than those with private insurance. Additionally, an inverse relationship between caregiver educational level and exposure to secondhand smoke in the home was observed. Recommendations are provided to improve health outcomes and address the disproportionate burden of asthma in such children.

Demographics and characteristics of wheezing/asthmatic children with repeat emergency department visits in O'ahu, Hawai'i.

A profile of Hawai'i's pediatric asthmatic patients who repeatedly visit the ED is lacking. This multi-centered prospective study found that repeat ED utilization occurs more frequently in a particular subset of patients. Characteristics of the asthmatic cohort can help health care providers, caregivers, children, and their families understand and better manage asthma as a chronic condition and improve quality of life.