Understanding personal asthma action plans

Personal asthma action plans (PAAPs) are written plans that help people with asthma to self-care and keep themselves as well as possible. PAAPs are usually developed in partnership with the patient or carer in primary care. PAAPs aim to ensure that people with asthma know how to manage their asthma and when to seek help if their condition deteriorates. To manage their asthma adequately at home, patients will need regular education about what asthma is, an understanding of their triggers, how their medications work and managing their devices. The practice nurse can play a key role in developing the PAAP, monitoring asthma control, and subsequently modifying the PAAP if necessary to maintain control of the condition.

Understanding personal asthma action plans

Personal asthma action plans are an essential tool to keep people with asthma as well as possible. Heather Henry explains the role of the practice nurse in developing them Personal asthma action plans (PAAPs) are written plans that help people with asthma to self-care and keep themselves as well as possible. PAAPs are usually developed in partnership with the patient or carer in primary care. PAAPs aim to ensure that people with asthma know how to manage their asthma and when to seek help if their condition deteriorates. To manage their asthma adequately at home, patients will need regular education about what asthma is, an understanding of their triggers, how their medications work and managing their devices. The practice nurse can play a key role in developing the PAAP, monitoring asthma control, and subsequently modifying the PAAP if necessary to maintain control of the condition.

PP349 Use Of Applications For Mobile Devices In Asthma Control: A Systematic Review Of Literature

IntroductionCell phones and information technology can be allies in the care of chronic diseases. Despite the wide availability of mobile device applications (apps), many offered by industry and providers, questions remain about the real efficacy of these technologies. The objective of this study was to evaluate the efficacy of mobile device apps designed for use by outpatients in treatment for asthma and describe its main characteristics and functionalities.MethodsA systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was conducted. MEDLINE and EMBASE were searched for randomized clinical trials (RCTs) evaluating the adoption of mobile apps on Android or iOS systems compared to the usual care, published in the last five years. Asthma control rate was defined as the primary outcome, and visits to emergency departments, hospitalizations and adherence to pharmacological treatment were secondary outcomes.ResultsFour RCTs (n = 415) met the inclusion criteria, two involving children and adults, and two only adults. Methodological quality was low to moderate. Common functionalities were asthma action plans, registration of the usual treatment, symptom diaries and educational alerts. Results were heterogeneous with respect to all outcomes evaluated. Study dropouts and lack of follow-up were frequent.ConclusionsThe clinical utility of mobile apps for asthma was evaluated in a few randomized studies; more data are necessary to establish the value of these technologies for asthma control.

Pediatric Asthma Action Plans: National Cross-Sectional Online Survey of Parents' Perceptions

Background Asthma Action Plans (AAPs) are recommended for pediatric patients to help improve asthma control. Studies have shown variable results for unscheduled doctor and emergency room visits. AAPs may have an impact on parental self-efficacy for asthma management as well as on other daily living factors that are valuable for patients and families, such as the number of missed school days and parental workdays, and on school and caregiver management. Objective The purpose of this study is to understand parent perceptions of AAPs. The goals of this analysis were threefold, including examining (1) the association between pediatric AAPs and parental self-efficacy, (2) parent perceptions of the helpfulness of an AAP for daily living factors, and (3) associations with the type of provider who gave the AAP (a primary care provider or an asthma specialist). Methods A national cross-sectional online survey was completed in October 2018 by parents of children with asthma aged 0-17 years. Survey questions included the presence or absence of a pediatric AAP, the Bursch Parental Self-efficacy for Asthma scale, parental perceptions of the AAP's helpfulness with regard to daily living factors ranked on a 5-point Likert scale, and the provider type who gave the AAP. Survey responses were summarized in terms of percentages or means and standard deviations. A 2-sample t test and analysis of covariance were used to compare self-efficacy for asthma and parental-perception-of-helpfulness scores between subjects with an AAP versus subjects without an AAP. All reported P values were 2-sided. Results A total of 704 parents with a child with asthma completed the survey. The parents had a mean age of 37.5 years (SD 10.9), and 82% (577/704) were women and 18% (127/704) were men. Most (564/704, 80%) parents had an AAP for their child; 65% (367/564) were written, 51% (286/564) were online, and 84% (474/564) were available at school. The Bursch Self-efficacy scale was significantly higher for parents with an AAP (mean 57.7, SD 8.6) versus no AAP (mean 55.1, SD 9.9; P<.001). Parents reported that they agreed/strongly agreed that an AAP was helpful for daily living factors, including managing asthma (446/544, 82%), decreased parental missed workdays (367/544, 68%), decreased child missed-school days (396/542, 73%), and for when a child is at school (422/541 78%), with other caregivers (434/543, 80%), doing normal activities (421/540 78%), and leading a normal life (437/540 81%). Parents agreed/strongly agreed that an AAP was helpful from all provider types: a pediatric provider (583/704, 82.8%), a family practice provider (556/704, 79%), and an asthma specialist (594/704, 84.4%). There was no significant difference (P=.53) between the type of provider who gave the AAP. Conclusions Parents who had pediatric AAPs for their children reported increased parental self-efficacy compared to those who did not have AAPs. Parents found AAPs helpful for decreasing missed time from work and school, and for asthma management when at home, school, and with other caregivers. Significant AAP helpfulness was seen regardless of the provider who gave the AAP, the parent's education, and income level. Findings support the usefulness of pediatric AAPs for families and the development of easily sharable electronic AAPs for children.

Completing asthma action plans by screen-sharing in video-consultations: practical insights from a feasibility assessment

Supported self-management is a vital component of routine asthma care. Completion of an agreed personalised asthma action plan is integral to implementation of this care, and traditionally this requires a face-to-face consultation. We aimed to assess the practical feasibility and potential utility of using screen-sharing technologies to complete asthma action plans remotely. Assisted by people with diverse technological ability and using a range of devices, we tested the technological feasibility of completing action plans in remote consultations using two leading video-conference systems. We used a semi-structured topic guide to check functionality and lead feedback discussions. Themes were interpreted using the Model for ASsessment of Telemedicine applications (MAST). Discussions with ten participants (age 20–74 years) revealed that screen-sharing was practical on most devices. Joint editing of an action plan (as was possible with Zoom) was considered to encourage participation and improve communication. Attend Anywhere had less functionality than Zoom, but the NHS badging was reassuring. Most participants appreciated the screen-sharing and considered it enabled a meaningful discussion about their action plan. Online shared completion of action plans is feasible with only a few (potentially remediable) practical problems. These findings suggest this may be a fruitful approach for further study—made more urgent by the imperative to develop remote consultations in the face of a global pandemic.

110 Improving Asthma Education in the Emergency Department: A Quality Improvement Initiative

Introduction/Background Asthma education and action plans have been shown to improve compliance and symptom control. Provincial guidelines, created in 2015, included asthma action plans, but use of these resources across our site was not consistent. Objectives The objectives of this study were to develop and implement an asthma education package, standardize discharge instructions and improve appropriate referrals to Asthma Clinics. Design/Methods Using process mapping, staff surveys and patient interviews, we undertook a current state analysis. The resulting change ideas were implemented between October 2018 and January 2020 in 5 PDSA (Plan Do Study Act) cycles, utilizing chart reviews and a standardized data tool to measure outcomes. Rates of repeat Emergency Department (ED) attendances, 2 weeks following the initial encounter and overall rates of ED asthma visits were assessed, using patient medical record data. Results Two-hundred-and-twenty-five ED presentations were reviewed, 65.2% (146/224) had a previous diagnosis of asthma. 48.9% (110/225) reported using an inhaled corticosteroid (ICS) at presentation. 89.7% (201/224) had not seen a healthcare provider during this acute illness. Asthma action plan utilization increased from 0% at baseline to an average of 60%, sustained over 2 years. 74.2% (167/225) had an ICS prescribed or advised at discharge. Only 3.8% (8/209) of patients re-presented to an ED within 2 weeks of this asthma visit. 57.3% (129/225) children were referred for ongoing pediatric care: either by a community pediatrician (72.9%; 94/129) or our hospital Asthma Clinic (34.8%; 32/129). Between 2017 and 2019, there was no significant change in total asthma presentations to our ED/per year (1300, 1395 and 1307, respectively) (Figure 1). Conclusion A standardized asthma education package including pre-printed discharge resources, asthma action plans, and a provincially adopted, multi-language education video was successfully implemented into our ED. This demonstrates a multi-disciplinary approach to asthma education that can be utilized across the province. Our data highlights the need for a strong community-based approach for asthma care, and further work is ongoing to assess the efficacy of this education package on medication compliance and recurrent ED visits.

Differences Between U.S. Workers With Asthma by Paid Sick Leave Status: An Analysis of the 2018 National Health Interview Survey

Having asthma is a chronic condition that requires both acute and preventive care as a vital component of asthma action plans. This study looks at how having access to paid sick leave days may be important to adherence to asthma action plans. Does having paid sick days facilitate preventive care, help people avoid acute asthma incidents, reduce the number of lost work days, reduce the cost of care, and lessen financial worry among asthma sufferers? This research builds on a growing body of literature that has established a relationship between paid sick leave days and preventive and acute health care use and outcomes and yet is the first of its kind to examine the relationship specifically between asthma and paid sick leave. This study used secondary data analysis to examine the relationship between six outcome variables categories and having paid sick leave in a nationally representative sample of N = 1,676 working U.S. adults in the National Health Interview Survey. Workers without paid sick leave benefits were significantly more likely to report they were worried about finances and struggle to afford their prescription medication compared to their counterparts who have paid sick leave benefits. Examined in light of past findings, workers with asthma who lack paid sick leave are in a precarious situation where they have increased worry likely due in part to reduced take-home pay due to unpaid sick days and increased medical expenses. There was no relationship between having paid sick leave and the receipt of preventive asthma care, measures of asthma control, receipt of patient education, and asthma medication use. Implications for policy and practice are put forth.