A framework for measuring self-management effectiveness and health care use among pediatric asthma patients and families

The entire primary care record of six patients attending a community-based education/exercise self-management program for chronic noncancer pain (YMCA Pain Exercise/Education Program [Y-PEP]) was reviewed. Medical visits, consultations and hospital admissions were coded as related or unrelated to their pain diagnoses. Mood disruption, financial concerns, conflicts with employers/insurers, analgesic doses, medication side effects and major life events were also recorded. The ‘chronic pain trajectory’ resembled a roller coaster with increased health care visits at the time of initial injuries and during ‘crises’ (reinjury, conflict with insurers/employers, failed back-to-work attempts and life events). Visits decreased when conflicts were resolved. Analgesic doses increased during ‘crises’ but did not fall after resolution. After attending Y-PEP, health care use fell for four of six patients and two returned to work. Primary care physicians need to recognize the functional limitations and psychosocial complications experienced by their chronic pain patients. A program such as Y-PEP may promote active self-management strategies resulting in lowered health care use.

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The feasibility, efficacy and efficiency of eHealth-supported pediatric asthma care implemented in daily clinical practice: a 6-month proof of concept study. (Preprint)

10.2196/preprints.24634 ◽

2020 ◽

Author(s):

Mattienne Kamp ◽

Pamela Hartgerink ◽

Jean MM Driessen ◽

Boony Thio ◽

Hermie Hermens ◽

...

Keyword(s):

Health Care ◽

Clinical Practice ◽

Early Detection ◽

Asthma Control ◽

Cost Efficiency ◽

Pediatric Asthma ◽

Self Management ◽

Intention To Use ◽

Proof Of Concept ◽

Asthma Care

BACKGROUND Strategies aimed at the early detection of loss of asthma control can effectively reduce the burden of the disease. However, broad implementation in clinical practice has not been accomplished so far. We are in need of research investigating the operationalization of eHealth pediatric asthma care in practice, revealing the most potential benefits in terms of adoption, efficiency and effectiveness. This may lay the foundation for targeted effectiveness studies with the lessons learned. OBJECTIVE The aim of this proof of concept study was to investigate the feasibility and explore the efficacy and cost-efficiency of an eHealth program implemented in daily clinical pediatric asthma practice. METHODS We designed an eHealth-supported pediatric asthma program facilitating early detection of loss of asthma control while increasing symptom awareness and self-management. Asthma control was monitored by objective home-measurements in the web-based Puffer-app to allow timely medical anticipation and prevent treatment delay. Children with moderate-to-severe asthma and a high medical consumption were asked to participate in the eHealth program for 6 months. The clinical feasibility was investigated by measures of participation and patient reported health and care outcomes. Moreover, the implementation experiences of the health care professionals (HCP’s) were evaluated in a focus group. Technical feasibility was investigated by measures of technology use, system usability and technology acceptance. The efficacy and cost-efficiency of the eHealth care were explored by comparing pre-post program differences in asthma outcomes (asthma control, lung function and therapy adherence) and medical consumption. RESULTS 35/41 children volunteered for participation, of which 30 finished the 6-month eHealth program. 75% of these children indicated that eHealth helped to control their asthma during the program. HCPs preferred making safe and substantiated medical decisions based on home measurements and real time communication with patients during symptoms. The Puffer-app scored highest on ease of use (77.1%) and intention to use (81.0%) and scored lowest on control over the system (64.4%) and enjoyment (65.6%). With an average patients’ time commitment of 15 minutes, eHealth care led to a 80% gross reduction in healthcare utilization, 8.6% increase (P =.40) in asthma control, 25.0% increase (P =.04) in the self-management level and a 20.4% improved (P =.02) therapy adherence. CONCLUSIONS Children and parents were eager to participate in the study, expressed a high intention to use the Puffer-app and indicated it was easy to work with. eHealth asthma care is feasible, enables safe remote care and is beneficial to the majority of asthmatic children in terms of health outcomes and health care utilization.

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Big Data Analysis: Why Not an Asthma APP?

10.28945/2216 ◽

2015 ◽

Author(s):

Quan Do ◽

Kris Robinson ◽

Son Tran

Keyword(s):

Health Care ◽

Big Data ◽

Chronic Disease ◽

Mobile App ◽

Self Management ◽

Care Providers ◽

Positive Adjustment ◽

Stage Of Development ◽

Number Of Patients ◽

Asthma Patients

Asthma and Chronic Obstructive Pulmonary Disease (COPD) is among the highest health diagnosis and therefore an economic drain, which puts substantial pressure on a huge number of patients, communities, and health systems. These chronic conditions are presently incurable but their symptoms can be controlled through quality health care, appropriate medications, and good self-management skills. Many asthma APPs have been developed to support asthma patients’ self-management of the disease. Asthma APPs are still in the infancy stage of development. Literature review indicates satisfaction to be equivocal. Moreover, available APPs have many unresolved issues, such as the following: (1) No APP provides comprehensive asthma information while at the same time possessing the characteristics of an efficient tool for self-management of the disease; (2) No APP has the ability to integrate data from disparate formats; (3) Not many APPs provide for two way communication between patients and Health Care Providers (HCPs) and support the providers decision making process; (4) No APP targets older adults. Different sources of data often imply data stored in inherently different formats. The integration of such data, culled from different databases requires use of Big Data (BD) techniques. The proposed asthma mobile APP aims to promote elderly asthma patients’ positive adjustment to this chronic disease by being an effective tool for patients to control their asthma triggers and support asthma self-management. Adjustment is a dynamic process and varies by individual. For that reason, a personalized asthma APP is necessary to control this chronic disease. The proposed asthma APP will allow patients to input their own asthma self-management data so the APP can identify patient personal triggers and will predict an asthma attack accordingly. Considering a patient’s individual determinants and uniqueness is required to push the patient’s positive adjustment to asthma since these elements affect the ability of individual to adapt to the illness. The paper reports our effort to establish the desirable characteristics for the next generation asthma APP and for a population segment not presently well served.

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Psychosocial Factors That Influence Health Care Use and Self-Management for African American and Latino Men With Type 2 Diabetes

The Journal of Men s Studies ◽

10.1177/1060826515582495 ◽

2015 ◽

Vol 23 (2) ◽

pp. 161-176 ◽

Cited By ~ 11

Author(s):

Jaclynn Hawkins ◽

Daphne C. Watkins ◽

Edith Kieffer ◽

Michael Spencer ◽

Nicolous Espitia ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Care ◽

African American ◽

Psychosocial Factors ◽

Health Care Use ◽

Self Management ◽

Latino Men

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Association of depression and anxiety with health care use and quality of life in asthma patients

Respiratory Medicine ◽

10.1016/j.rmed.2006.06.002 ◽

2007 ◽

Vol 101 (3) ◽

pp. 638-644 ◽

Cited By ~ 81

Author(s):

Antje Kullowatz ◽

Frank Kanniess ◽

Bernhard Dahme ◽

Helgo Magnussen ◽

Thomas Ritz

Keyword(s):

Quality Of Life ◽

Health Care ◽

Health Care Use ◽

Depression And Anxiety ◽

Asthma Patients

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Measurement of Key Constructs in a Holistic Framework for Assessing Self-Management Effectiveness of Pediatric Asthma

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16173060 ◽

2019 ◽

Vol 16 (17) ◽

pp. 3060 ◽

Cited By ~ 3

Author(s):

Pavani Rangachari ◽

Kathleen R. May ◽

Lara M. Stepleman ◽

Martha S. Tingen ◽

Stephen Looney ◽

...

Keyword(s):

Family Communication ◽

Asthma Management ◽

Pediatric Asthma ◽

Ecological Factors ◽

Self Management ◽

Management Effectiveness ◽

Children With Asthma ◽

Patient Partnership ◽

Asthma And Allergy

The 2007 U.S. National Institutes of Health EPR-3 guidelines emphasize the importance creating a provider-patient partnership to enable patients/families to monitor and take control of their asthma, so that treatment can be adjusted as needed. However, major shortfalls continue to be reported in provider adherence to EPR-3 guidelines. For providers to be more engaged in asthma management, they need a comprehensive set of resources for measuring self-management effectiveness of asthma, which currently do not exist. In a previously published article in the Journal of Asthma and Allergy, the authors conducted a literature review, to develop a holistic framework for understanding self-management effectiveness of pediatric asthma. The essence of this framework, is that broad socioecological factors can influence self-agency (patient/family activation), to impact self-management effectiveness, in children with asthma. A component of socio-ecological factors of special relevance to providers, would be the quality of provider-patient/family communication on asthma management. Therefore, the framework encompasses three key constructs: (1) Provider-patient/family communication; (2) Patient/family activation; and (3) Self-management effectiveness. This paper conducts an integrative review of the literature, to identify existing, validated measures of the three key constructs, with a view to operationalizing the framework, and discussing its implications for asthma research and practice.

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