使用经过验证的哮喘问卷来增加儿科急诊中吸入皮质类固醇的处方。
Use of a validated asthma questionnaire to increase inhaled corticosteroid prescribing in the pediatric emergency department.
机构信息
Pediatric Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.
University of Southern California, Los Angeles, CA, USA.
出版信息
J Asthma. 2022 Feb;59(2):378-385. doi: 10.1080/02770903.2020.1841225. Epub 2020 Nov 13.
BACKGROUND
Asthma guidelines recommend assessment of asthma control and treatment with an ICS when appropriate. Children seen for asthma in the ED often have poorly controlled asthma. Validated questionnaires are rarely used in the ED and ICS are prescribed at less than 5% of ED asthma encounters, leaving many children at risk for continued poor outcomes.
OBJECTIVE
To determine if use of a validated asthma questionnaire can increase the proportion of children who receive an ICS prescription during an ED asthma visit.
METHODS
We administered a validated asthma questionnaire (Pediatric Asthma Control and Communication Instrument-ED version [PACCI-ED]) to parents of children 2 - 17 years old presenting for asthma care at a large, urban, academic pediatric ED. Based on national asthma guidelines, the PACCI-ED results were used to determine ICS dose recommendations. ED physicians reviewed the PACCI-ED results and ICS dose recommendations and chose whether to prescribe an ICS upon discharge. ICS prescribing rates during the intervention period were assessed via medical record review and compared to historical controls. We also surveyed parents to examine the association of sociodemographic factors with receipt of an ICS prescription, and surveyed physicians regarding their prescribing decisions.
RESULTS
Thirteen physicians and seventy-nine children participated. Historically, the ICS prescribing rate for asthma exacerbations discharged from the ED was 13%. The intervention increased ICS prescribing to 56% ( < 0.001). Children with ≥2 asthma exacerbations in the prior year ( < 0.02) and those with moderate-severe persistent asthma ( < 0.02) were more likely to receive an ICS prescription. There were no statistically significant differences in ICS prescribing by sociodemographic characteristics.
CONCLUSION
A validated asthma questionnaire increased ICS prescribing for children presenting for to the ED for asthma care. Additional strategies are needed to promote prescribing in this setting and ensure that all eligible children receive guideline-based asthma care.
背景
哮喘指南建议评估哮喘控制情况，并在适当情况下使用 ICS 进行治疗。在急诊科就诊的哮喘患儿通常哮喘控制不佳。在急诊科很少使用经过验证的问卷，并且在急诊科哮喘就诊中，只有不到 5%的患儿开具了 ICS 处方，这使得许多患儿面临持续不良结局的风险。
目的
确定在急诊科哮喘就诊中使用经过验证的哮喘问卷是否可以增加开具 ICS 处方的患儿比例。
方法
我们向在大型城市学术儿科急诊科就诊的 2 至 17 岁哮喘患儿的父母发放了经过验证的哮喘问卷（儿科哮喘控制和沟通工具-急诊科版[PACCI-ED]）。根据国家哮喘指南，PACCI-ED 的结果用于确定 ICS 剂量建议。急诊科医生查看 PACCI-ED 的结果和 ICS 剂量建议，并在出院时选择是否开具 ICS 处方。通过病历回顾评估干预期间的 ICS 处方率，并与历史对照进行比较。我们还调查了父母，以研究社会人口因素与开具 ICS 处方之间的关系，并调查了医生的处方决策。
结果
13 名医生和 79 名患儿参与了研究。在历史上，从急诊科出院的哮喘加重患儿的 ICS 处方率为 13%。干预措施将 ICS 处方率提高到 56%（ < 0.001）。在过去 1 年中哮喘加重≥2 次的患儿（ < 0.02）和中重度持续性哮喘患儿（ < 0.02）更有可能开具 ICS 处方。ICS 处方开具与社会人口特征之间无统计学差异。
结论
经过验证的哮喘问卷增加了急诊科就诊的哮喘患儿开具 ICS 处方的比例。需要采取额外的策略来促进该环境下的处方开具，并确保所有符合条件的患儿都能获得基于指南的哮喘护理。
Zotero 插件