Effects of Asthma Education on Children's Use of Acute Care Services: A Meta-analysis

Institute for Health Policy Studies, University of California, 3333 California St, Suite 265, San Francisco, CA 94118, USA.
PEDIATRICS (Impact Factor: 5.47). 04/2008; 121(3):575-86. DOI: 10.1542/peds.2007-0113
Source: PubMed


National Heart, Lung, and Blood Institute clinical practice guidelines strongly recommend that health professionals educate children with asthma and their caregivers about self-management. We conducted a meta-analysis to estimate the effects of pediatric asthma education on hospitalizations, emergency department visits, and urgent physician visits for asthma.
Inclusion criteria included enrollment of children aged 2 to 17 years with a clinical diagnosis of asthma who resided in the United States. Pooled standardized mean differences and pooled odds ratios were calculated. Random-effects models were estimated for all outcomes assessed.
Of the 208 studies identified and screened, 37 met the inclusion criteria. Twenty-seven compared educational interventions to usual care, and 10 compared different interventions. Among studies that compared asthma education to usual care, education was associated with statistically significant decreases in mean hospitalizations and mean emergency department visits and a trend toward lower odds of an emergency department visit. Education did not affect the odds of hospitalization or the mean number of urgent physician visits. Findings from studies that compared different types of asthma education interventions suggest that providing more sessions and more opportunities for interactive learning may produce better outcomes.
Providing pediatric asthma education reduces mean number of hospitalizations and emergency department visits and the odds of an emergency department visit for asthma, but not the odds of hospitalization or mean number of urgent physician visits. Health plans should invest in pediatric asthma education or provide health professionals with incentives to furnish such education. Additional research is needed to determine the most important components of interventions and compare the cost-effectiveness of different interventions.

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Available from: Helen Halpin, Oct 26, 2014
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    • "Un certain nombre d'e ´tudes e ´valuant l'impact d'une action e ´ducative sont parues outre-Atlantique, quelques unes en Europe et en Suisse [14] [15] [16]. Du fait de la grande disparité des programmes, aucun consensus concernant le meilleur modèle d'e ´ducation thérapeutique n'a pu e ˆtre validé [2] [14] [17]. L'E ´ cole de l'asthme (EA) de l'hôpital de l'Enfance de Lausanne (HEL) a pour but d'améliorer l'adhésion thérapeutique des patients en leur permettant de mieux gérer la maladie au quotidien. "
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    ABSTRACT: Asthma is the most frequent chronic disease in children. Many educational approaches to asthma exist, but there is no evidence of their effectiveness because of the heterogeneity of practices. Several studies show that good knowledge of the disease associated with personal skills and optimal medication improve treatment compliance and decrease school absenteism and asthma exacerbations. The "Asthma School" conducted in the Children's Hospital of Lausanne, Switzerland is in keeping with these recommendations. The aim of the study was to evaluate the impact of Asthma School (therapeutic education) on the number of medical visits in asthmatic children. We also assessed the quality of life of children and their caregivers. We included in a prospective longitudinal study every child aged 4 to 12 years and their parents attending Asthma School over 1 year and followed them at 6 months. The number of emergency visits, medical appointments, and hospitalizations during the year before and after Asthma School was assessed with a questionnaire administered to the family physicians (GPs, pediatricians). Quality of life was evaluated with the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) at inclusion and 6 months after. Twenty-seven children and their parents were included. The mean age was 7.02 years. Pediatric visits, emergency visits, and hospitalizations decreased significantly between the year before and the year after Asthma School. Emergency visits were 41, 1 year before Asthma School and 21, 1 year after it, medical appointments were 62 vs 30, and hospitalizations were 17 vs 2, respectively. The Wilcoxon sign-rank test demonstrates a significant difference with P=0.010 for medical appointments, P=0.021 for emergency visits, and P=0.002 for hospitalizations. Quality of life in children improved in all domains but one evaluated by the PAQLQ(S) (score of 5.90 vs 6.52). Parental quality of life (PACQLQ) improved in all domains (overall score of 5.21 vs 6.15). Interactive education on asthma improves clinically important outcomes and quality of life in children and their families. The skills acquired allow them to manage daily life.
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