Abstract
Objective Asthma is one of the commonest causes of morbidity and mortality in childhood. The goals of the present study were to design a valid medication assessment tool for evaluating the quality of medication use according to recommendations of updated asthma guidelines for children aged from 5 to 12 years, and to quantify adherence to guideline recommendations. Setting Two primary care settings in Scotland, UK. Methods Recommendations related to the long-term management of asthmatic children in the British Thoracic Society/Scottish Intercollegiate Guidelines Network and Global Initiative for Asthma guidelines were identified and corresponding criteria were created. These criteria were incorporated to generate an assessment tool named MAT ASTHMA-PAED. Two phases of field-testing were undertaken and the tool was also subject to examination by a focus group of specialist practitioners. Thereafter, MAT ASTHMA-PAED was modified accordingly. Main outcome measure Applicability and adherence to each criterion and overall adherence to the MAT ASTHMA-PAED. Results The MAT ASTHMA-PAED field-testing was undertaken in two primary care practices in Scotland, United Kingdom and 77 asthmatic children were recruited. Results of the pilot study field-testing showed a high overall adherence of 70.0 % (95 % CI: 58.7–81.3 %) to the guidelines. Low adherence (<50 %) was seen for 4 criteria, whereas 8 criteria were considered high-adherence criteria (>70 %). The final MAT ASTHMA-PAED comprised of 25 criteria was produced based on the results of field testing and the opinions from the focus group. Conclusion Although high utility of MAT ASTHMA-PAED criteria was found, there were gaps in the implementation of certain recommendations, particularly in relation to demonstrated satisfactory technique of inhaler. Moreover, further studies assessing the use of oral steroids and exercise-induced asthma, and wider implementation of MAT ASTHMA-PAED are required.
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References
Butland BK, Strachan DP, Crawley-Boevey EE, et al. Childhood asthma in South London: trends in prevalence and use of medical services 1991–2002. Thorax. 2006;61:383–7.
Herborg H, Soendergaard B, Jorgensen T, et al. Improving drug therapy for patients with asthma- part 2. J Am Pharm Assoc. 2001;41:551–9.
Cordina M, McElnay JC, Hughes CM. Assessment of a community pharmacy-based program for patients with asthma. Pharmacotherapy. 2001;21:1196–203.
Håkonsen GD, Strelec P, Campbell D, Hudson S, Loennechen T. Adherence to medication guideline criteria in cancer pain management. J Pain Symptom Manage. 2008;37:1006–18.
Cabana MD, Bruckman D, Meister K, Bradley JF, Clark N. Documentation of asthma severity in pediatric outpatient clinics. Clin Pediatr (Phila). 2003;42:121–5.
Cloutier MM, Hall CB, Wakefield DB, Bailit H. Use of asthma guidelines by primary care providers to reduce hospitalisations and emergency department visits in poor, minority, urban children. J Pediatr. 2005;146:591–7.
Miller K, Ward-Smith P, Cox K, Jones EM, Portnoy JM. Development of an asthma disease management program in a children’s hospital. Curr Allergy Asthm R. 2003;3:491–500.
Weiss KB, Wagner R. Performance measurement through audit, feedback, and profiling as tools for improving clinical care. Chest. 2000;118:S53–8.
Collins S, Beilby J, Fardy J, Burgess T, Johns R, Booth B. The national asthma audit. Bridging the gap between guidelines and practice. Aust Fam Physician. 1998;27:907–13.
British Thoracic Society/Scottish Intercollegiate (BTS/SIGN) Guidelines Network. British guideline on the management of asthma. November 2005.
Global Initiative for Asthma (GINA). Workshop Report. Global strategy for asthma management and prevention. 2005.
Behrman RE: Nelson textbook of pediatrics. In: Liu AH, Spahn JD, Leung DY. Chapter 134: Childhood asthma. 17th ed. St. Louis: Saunder, An Imprint of Elsevier; 2004.
Sharek PJ, Bergman DA. The effect of inhaled steroids on the linear growth of children with asthma: a meta-analysis. Pediatrics. 2000;106:e8.
Wolf FM, Guevara JP, Grum CM, Clark NM, Cates CJ. Educational interventions for asthma in children. The Cochrane Database of Systematic Reviews. June 2005.
Toelle BG, Ram FSF. Written individualised management plans for asthma in children and adults. The Cochrane Database of Systematic Reviews. November 2004.
Perez MG, Feldman L, Caballero F. Effects of a self-management educational program for the control of childhood asthma. Patient Educ Couns. 1999;36:47–55.
Carlsen KH, Carlsen KC. Exercise-induced asthma. Paediatr Respir Rev. 2002;3:154–60.
Massie J. Exercise-induced asthma in children. Pediatr Drugs. 2002;4:267–78.
Acknowledgments
The authors would like to give the sincerest thanks and memory to the late Professor Steve Hudson, for his guidance to the study. The authors also thank Richard Lowrie, Victoria Hunt, and Sheila Tennant for making all of the arrangements for data collection at the primary settings. Thanks are also extended to Jacqui William, manager of the Elmwood practice, and the staff at the Elmwood Practice and the Mearns Practice where the field-testing was undertaken.
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Liu, HP., Chen, HY., Johnson, J. et al. A medication assessment tool to evaluate adherence to medication guideline in asthmatic children. Int J Clin Pharm 35, 289–295 (2013). https://doi.org/10.1007/s11096-012-9702-7
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DOI: https://doi.org/10.1007/s11096-012-9702-7