Kwok Maria Y, Pusic Martin V, Cabrera Keven I, York Deborah V, Lee June, Evans David
Departments of Emergency Medicine and Pediatrics, New York University Langone Medical Center New York.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead.
Pediatr Emerg Care. 2018 Sep;34(9):636-640. doi: 10.1097/PEC.0000000000001607.
The aim of this study was to identify the educational needs of inner-city children with persistent asthma and their caregivers who utilize the emergency department (ED) for asthma care as well as determine their guideline adherence, factors associated with ED use, and comfort with computers.
Cross-sectional survey of children aged 2 to 18 years with previous diagnosis of asthma presenting with asthma-related complaints or acute asthma exacerbations to an urban pediatric ED. Data on demographics, families' response to acute asthma, approach to asthma prevention, access to care, educational topics of interest, and sources of health information were collected.
Of approximately 1500 asthma-related visits, 218 caregivers were approached, and 200 completed the survey. In the past 12 months, 31% had experienced at least 1 asthma-related hospitalization, and 55.5% had had at least 3 ED visits. Although 184 (92.9%) of 198 caregivers were able to identify a primary physician, 37% reported they were more likely to take their child to the ED in response to acute asthma during the day as opposed to their physician (17%). Approximately half of patients were not on any preventive medication, with 57% not having had received an Asthma Action Plan. Caregivers expressed the most interest in learning about long-term controller medications (44.2%), use of metered dose inhalers or nebulizers (44.2%), and trigger avoidance (35.2%). Most caregivers (approximately 68%) reported ease of use with computers and the Internet.
There was discordance between caregivers' reports of primary care provider teaching on asthma management and the use of the controller medications and possession of the Asthma Action Plans for persistent asthma. Education could focus on caregiver concerns of the safety and benefits of the controller medications.
本研究旨在确定患有持续性哮喘的市中心儿童及其利用急诊科（ED）进行哮喘护理的照顾者的教育需求，同时确定他们对指南的遵循情况、与急诊就诊相关的因素以及对计算机的熟悉程度。
对2至18岁曾被诊断为哮喘且因哮喘相关主诉或急性哮喘加重而前往城市儿科急诊科就诊的儿童进行横断面调查。收集了有关人口统计学、家庭对急性哮喘的应对措施、哮喘预防方法、获得护理的途径、感兴趣的教育主题以及健康信息来源的数据。
在大约1500次与哮喘相关的就诊中，接触了218名照顾者，其中200名完成了调查。在过去12个月中，31%的人至少经历过1次与哮喘相关的住院治疗，55.5%的人至少去过急诊3次。尽管198名照顾者中有184名（92.9%）能够说出其孩子的初级医生，但37%的人报告称，与在白天带孩子看医生（17%）相比，他们更有可能在孩子急性哮喘发作时带其去急诊。大约一半的患者未使用任何预防性药物，57%的患者未收到哮喘行动计划。照顾者对了解长效控制药物（44.2%）、定量吸入器或雾化器的使用（44.2%）以及避免触发因素（35.2%）表现出最大兴趣。大多数照顾者（约68%）报告称使用计算机和互联网很方便。
照顾者关于初级保健提供者对哮喘管理的教导以及长效控制药物的使用和持续性哮喘患者持有哮喘行动计划的报告之间存在不一致。教育可侧重于照顾者对控制药物安全性和益处的担忧。
