Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St., Houston, TX, 77030, USA.
J Racial Ethn Health Disparities. 2019 Aug;6(4):660-667. doi: 10.1007/s40615-019-00564-1. Epub 2019 Feb 6.
Most pediatric emergency departments' (ED) quality improvement (QI) initiatives for asthma aim to standardize care based on the priorities of healthcare providers. Perceptions and priorities of the caregiver rarely are addressed, especially in families with limited English-language proficiency. We explored Spanish-speaking caregivers' perceptions, understandings, and barriers with the care they received for asthma, after exposure to an ED asthma-care bundle. This qualitative study was part of a larger QI initiative on Spanish-speaking caregivers of patients presenting to a children's hospital ED with an asthma exacerbation. Patients were exposed to an asthma-care bundle, which included timely administration of medication, home dose of medications, an educational intervention, asthma action plans (AAPs), and discharge instructions. Through semi-structured interviews and qualitative analyses, we assessed the perceptions, understandings, and barriers caregivers reported during their ED experience. From January 2015 to October 2016, 492 patients received AAPs in the ED. Of 128 families that preferred Spanish, 88 (69%) received a Spanish AAP, 41 (32%) received Spanish discharge instructions, and 34 (27%) received discharge materials in both languages. Thirteen families were interviewed. Three themes emerged regarding the caregivers' perceived barriers: (1) need for improved accessibility to medication, primary care, and insurance; (2) communication barriers, such as timeliness, availability of interpreters, and need for resources in their preferred language; and (3) uncertainty about the child's diagnosis and acuity. Incorporating the caregivers' perspectives into QI projects may yield valuable information when developing new interventions. In the ED, improving accessibility to interpreters and providing discharge materials in their preferred language, as well as addressing misconceptions about asthma, may enhance caregivers' satisfaction.
大多数儿科急诊部（ED）的哮喘质量改进（QI）计划旨在根据医疗保健提供者的优先事项来规范护理。很少关注照顾者的看法和优先事项，尤其是在英语水平有限的家庭中。在接触 ED 哮喘护理套餐后，我们研究了讲西班牙语的照顾者对他们接受的哮喘护理的看法，理解和障碍。这项定性研究是对西班牙语患者就诊于儿童医院 ED 出现哮喘加重的较大 QI 计划的一部分。向患者提供了哮喘护理套餐，其中包括及时给药，家庭剂量的药物，教育干预，哮喘行动计划（AAP）和出院说明。通过半结构化访谈和定性分析，我们评估了照顾者在 ED 经历中报告的看法，理解和障碍。从 2015 年 1 月至 2016 年 10 月，ED 中为 492 名患者提供了 AAP。在 128 个首选西班牙语的家庭中，有 88 个（69％）获得了西班牙语 AAP，41 个（32％）获得了西班牙语出院说明，34 个（27％）获得了两种语言的出院材料。对 13 个家庭进行了访谈。关于照顾者认为的障碍出现了三个主题：（1）需要改善药物，初级保健和保险的可及性；（2）沟通障碍，例如及时性，口译员的可用性以及在首选语言中提供资源的需求；以及（3）对孩子的诊断和严重程度的不确定性。在制定新的干预措施时，将照顾者的观点纳入 QI 项目可能会提供有价值的信息。在 ED 中，改善口译员的可及性并提供其首选语言的出院材料，并解决有关哮喘的误解，可能会提高照顾者的满意度。
