Pediatric Emergency Medicine, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA.
Pediatric Emergency Medicine, Children's Mercy Hospital and Clinics, Kansas City, MO, USA.
J Asthma. 2021 Jun;58(6):819-824. doi: 10.1080/02770903.2020.1731824. Epub 2020 Mar 6.
Among children presenting to the pediatric emergency department (PED) with an asthma exacerbation, the objective was to determine if creating an individualized written asthma action plan (WAAP) during the PED visit, when compared with standard discharge instructions, led to fewer asthma-related unplanned return visits up to three months after the PED visit. Secondary outcomes included rates of routine follow up with a healthcare provider, asthma control scores and caregiver confidence measures. Children ages 2-17 who presented to the PED with an asthma exacerbation and did not already have a WAAP were randomized to receive discharge instructions including a WAAP versus standard discharge instructions. The WAAP was ordered by the physician and reviewed with families by a respiratory therapist as part of a brief educational session during the PED visit. Parents completed follow-up surveys at one and three months after the PED visit. 91 families were enrolled and 83/91 (91%) completed at least one follow-up survey. Fewer families in the WAAP group reported an unplanned visit to a healthcare provider during the follow-up period [WAAP 7/39 (18%), Control 17/44 (39%), = 0.038]. Inhaled corticosteroids were prescribed more commonly in the WAAP group [WAAP 29/45 (64%), Control 15/46 (33%), = 0.002]. There was no difference in rates of routine follow-up visits, asthma control scores or caregiver confidence measures during the follow-up period. Families who were provided a written asthma action plan during their pediatric emergency department visit for an asthma exacerbation reported fewer unplanned visits during the subsequent three months.
在因哮喘加重而到儿科急诊就诊的儿童中，目的是确定在儿科就诊期间制定个体化书面哮喘行动计划（WAAP）与标准出院医嘱相比，是否会导致在儿科就诊后三个月内与哮喘相关的计划外复诊次数减少。次要结局包括与医疗保健提供者进行常规随访的比率、哮喘控制评分和护理人员信心措施。年龄在 2-17 岁之间、因哮喘加重而到儿科急诊就诊且尚未制定 WAAP 的儿童被随机分配接受包括 WAAP 在内的出院医嘱或标准出院医嘱。WAAP 由医生开具，并由呼吸治疗师在儿科就诊期间的简短教育课程中与家属一起进行审查。家长在儿科就诊后一个月和三个月完成随访调查。共有 91 个家庭入组，83/91（91%）个家庭完成了至少一次随访调查。在随访期间，WAAP 组报告计划外就诊的家庭较少[WAAP 组 7/39（18%），对照组 17/44（39%），=0.038]。WAAP 组更常开具吸入皮质类固醇[WAAP 组 29/45（64%），对照组 15/46（33%），=0.002]。在随访期间，常规随访就诊率、哮喘控制评分或护理人员信心措施没有差异。在儿科急诊就诊期间为哮喘加重制定书面哮喘行动计划的家庭在随后的三个月内报告计划外就诊次数减少。
