| Written action plan in pediatric emergency room improves asthma prescribing, adherence, and control. | |
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MedLine Citation:
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PMID: 20802165 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Rationale: An acute-care visit for asthma often signals a management failure. Although a written action plan is effective when combined with self-management education and regular medical review, its independent value remains controversial. Objectives: We examined the efficacy of providing a written action plan coupled with a prescription (WAP-P) to improve adherence to medications and other recommendations in a busy emergency department. Methods: We randomized 219 children aged 1-17 years to receive WAP-P (n = 109) or unformatted prescription (UP) (n = 110). All received fluticasone and albuterol inhalers, fitted with dose counters, to use at the discretion of the emergency physician. The main outcome was adherence to fluticasone (use/prescribed × 100%) over 28 days. Secondary outcomes included pharmacy dispensation of oral corticosteroids, β(2)-agonist use, medical follow-up, asthma education, acute-care visits, and control. Measurements and Main Results: Although both groups showed a similar drop in adherence in the initial 14 days, adherence to fluticasone was significantly higher over Days 15-28 in children receiving WAP-P (mean group difference, 16.13% [2.09, 29.91]). More WAP-P than UP patients filled their oral corticosteroid prescription (relative risk, 1.31 [1.07, 1.60]) and were well-controlled at 28 days (1.39 [1.04, 1.86]). Compared with UP, use of WAP-P increased physicians' prescription of maintenance fluticasone (2.47 [1.53, 3.99]) and recommendation for medical follow-up (1.87 [1.48, 2.35]), without group differences in other outcomes. Conclusions: Provision of a written action plan significantly increased patient adherence to inhaled and oral corticosteroids and asthma control and physicians' recommendation for maintenance fluticasone and medical follow-up, supporting its independent value in the acute-care setting. Clinical trial registered with www.clinicaltrials.gov (NCT 00381355). |
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Authors:
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Francine M Ducharme; Roger L Zemek; Dominic Chalut; David McGillivray; Francisco J D Noya; Sandy Resendes; Lyudmyla Khomenko; Rachel Rouleau; Xun Zhang |
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Publication Detail:
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Type: Journal Article Date: 2010-08-27 |
Journal Detail:
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Title: American journal of respiratory and critical care medicine Volume: 183 ISSN: 1535-4970 ISO Abbreviation: Am. J. Respir. Crit. Care Med. Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2011-01-18 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9421642 Medline TA: Am J Respir Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 195-203 Citation Subset: AIM; IM |
Affiliation:
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Department of Pediatrics, Research Centre, CHU Sainte-Justine, 3175 Côte Ste-Catherine, Room 7939, Montreal, PQ, H3T 1C5 Canada. francine.m.ducharme@umontreal.ca. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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