pediatric asthma management by resident and attending physicians in a suburban hospital

1
58.1%). Fifty percent of patients in both groups discontinued omalizumab (mean 5 44.7 6 39.5 weeks), with cost/insurance and perceived lack of efficacy identified as the most common reasons. No systemic reactions occurred in either group. CONCLUSIONS: Our findings suggest that outcomes in patients with moderate-to-severe refractory asthma and total serum IgE levels > 700 IU/ L who receive omalizumab are comparable to those patients with IgE levels between 30-700 IU/L. A substantial proportion of patients who initiate omalizumab suspend treatment. Funding: The William Wagner Research and Education Fund 158 Cost Effectiveness of Multi-Systemic Therapy for Adherence in Adolescents with High Risk Asthma A. Kujawska, P. Patel, A. Walker, W. Alame, P. Toarmina, S. Naar-King, D. Ellis, E. Secord; Wayne State University, Children’s Hospital of Mich- igan, Detroit, MI. RATIONALE: To determine cost effectiveness of multi-systemic therapy (MST) for adherence in high-risk asthmatic adolescents. METHODS: 8 adolescents from our high risk asthma clinic were recruited for MST because of poor therapy adherence. The in home/community based intensive adherence therapy was given over a six month period. ER visits and hospitalizations for each patient at 6 months prior to intervention, during, and 6 months post therapy were recorded. Analysis via two tailed, paired t-test was performed. RESULTS: Total hospitalizations/ER visits for six months preceding MST intervention was 19 and dropped to 2 during intervention (n 5 8; pre 5 19; during 5 2; p 5 0.003). Hospitalizations/ER visits at 6 months post intervention were still significantly lower than baseline (n 5 6; pre 5 13 and post 5 2; p 5 0.02). The estimated hospitalization/ER cost in one year prior to MST therapy was $109,380.34. Cost of hospitalizations/ER visits one year post MST was approximately $11,513.72. Therapist cost for one year was $22,000.00. Savings per year estimated at $75,866.62 for 8 patients. CONCLUSIONS: In high-risk asthmatic adolescents MST therapy for adherence decreases hospitalizations and ER visits significantly and is cost effective despite intensive nature of therapy. Funding: Michigan Department of Public Health and Children’s Research Center of Michigan. 159 Using the Asthma Control Trackerä Web-Based System to Monitor Outcomes and Facilitate Adoption of the Asthma Control Testä in Ambulatory Asthma Management C. Dinakar 1 , J. Portnoy 1 , D. Lynch 1 , T. Pendergraft 2 ; 1 Children’s Mercy Hospital/University of Missouri-Kansas City, Kansas city, MO, 2 Glaxo SmithKline, Chapel Hill, NC. RATIONALE: To describe the implementation of the Partnership for Asthma Controlä, a quality improvement (QI) project to facilitate adoption of NIH guidelines. METHODS: Pediatric clinical teams of asthma specialists (n 5 13) and primary care clinicians (n 5 7) at Children’s Mercy Hospital used the Plan- Do-Study-Act model to implement the QI project. During patient encoun- ters, the team used a paper Visit Planner to administer the Asthma Control Testä, the Childhood Asthma Control Test and to collect other assessments (FEV 1 , exhaled nitric oxide, asthma-action plans). The ACT surveys are validated to quickly assess asthma control in children 12 years (ACT) and 4-11 years (Childhood ACT). A score of 19 suggests asthma that may not be as well controlled as it could be. Providers recorded asthma medications prescribed by class. Data from the Visit Planner were entered into the Asthma Control Trackerä web-based registry. RESULTS: Stepwise implementation of the project included systematic education of providers regarding NIH guidelines, multidisciplinary team involvement, data management using web-based tracker, and provider- feedback incentives to encourage participation. Since March 2007, a total of 612 pediatric asthmatics have been tracked, 522 from asthma specialists (65% with persistent asthma) and 90 from primary care (53% with persistent asthma). The mean ACT (n 5 212) and Childhood ACT (n 5 390) scores were 20. Of patients with scores 19, 39% were seen by specialists, 43% by primary care, and 95% were prescribed controller medications. CONCLUSIONS: In the first cycle of this QI project, we have success- fully implemented adoption of the Partnership for Asthma Control in the primary and specialty care settings. 160 Pediatric Asthma Management by Resident and Attending Physicians in a Suburban Hospital M. D. Ober, M. Balasubramaniam, D. R. Doshi; William Beaumont Hospital, Royal Oak, MI. RATIONALE: In anticipation of the new asthma guidelines (National Heart Lung Blood Institute, Expert Panel Report III), we developed a survey to evaluate the consistency of care in patients with asthma between residents and attending physicians. METHODS: A blinded questionnaire was distributed to all Pediatric and Medicine-Pediatric residents, attending physicians in the Pediatric resident clinic, and community Pediatricians in private practice. The survey focused on asthma education during clinic visits including: use of written instructions for mediations, review of inhaler technique, peak flow use, and distribution of written asthma action plans. RESULTS: A total of 340 surveys were mailed out to attending physi- cians, of which, 79 were completed and returned (23.8%). Additionally, 34 surveys were sent to resident physicians, with 18 completed (52.9%). The majority of all surveyed physicians provided written instructions regarding medication usage (78% residents, 86% attendings). Inhaler technique was reviewed by all attending and 76.5% of resident physicians. Peak flow meters were not consistently recommended (47.1% of residents, 32.9% attendings). Written asthma action plans were provided by 51.9% of attending and only 5.6% of resident physicians. Attending physicians tend to provide written asthma action plans more often than residents (p-value 5 0.0015). CONCLUSIONS: There is a significant difference in asthma education provided by attending and resident physicians, most notably the use of written asthma action plans. Despite these differences, there is ample room for improvement in providing consistent asthma education in the outpatient setting. 161 Effects of Different Maintenance Methods of Cone Spacer and Priming Spacer Increasing Doses of Drugs before Use on Electrostatic Charges of Cone Spacer S. Nanthapisal, M. Vangveeravong; Queen Sirikit National Institute of Child Health, Bangkok, THAILAND. RATIONALE: To study effects of maintenance methods of cone spacer which is Thailand’s product and widely used in Thailand, on electrostatic charges on surface of spacer. Maintenance methods are cleaning spacer with water, cleaning spacer with detergent and priming spacer before use with increasing puffs of each pressurized metered dose inhaler drugs (Salbutamol, Budesonide, Fluticasone/Salmeterol). METHODS: Measure and compare electrostatic charges of new cone spacer, spacer cleaned with water and spacer cleaned with detergent. Then prime all 3 groups of spacer with increasing doses (2, 4, 6,.20 puffs) of Salbutamol, Budesonide and Fluticasone/Salmeterol then measure and compare electrostatic charges after priming each 2 doses of each drug. RESULTS: Cleaning spacer with detergent decreased electrostatic charges on spacer better than cleaning with water significantly (p 5 0.038). Each increasing doses of priming of all 3 drugs significantly changed electrostatic charges on spacer. But priming Budesonide which is positive charges into new spacers which have negative charges signifi- cantly increased electrostatic charges on spacers. And also found precipi- tation of Budesonide aerosol on surface of spacer. CONCLUSIONS: Cleaning spacer with detergent significantly decreased amounts of electrostatic charges on spacer and better than rinsing in water. And there is benefit of priming drug before use only when priming budesonide more than 20 puffs on new spacer. Cleaning spacer with detergent is enough to decrease electrostatic charges on spacer. J ALLERGY CLIN IMMUNOL VOLUME 121, NUMBER 2 Abstracts S41 SATURDAY

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Page 1: Pediatric Asthma Management by Resident and Attending Physicians in a Suburban Hospital

J ALLERGY CLIN IMMUNOL

VOLUME 121, NUMBER 2

Abstracts S41

SA

TU

RD

AY

58.1%). Fifty percent of patients in both groups discontinued omalizumab

(mean 5 44.7 6 39.5 weeks), with cost/insurance and perceived lack of

efficacy identified as the most common reasons. No systemic reactions

occurred in either group.

CONCLUSIONS: Our findings suggest that outcomes in patients with

moderate-to-severe refractory asthma and total serum IgE levels > 700 IU/

L who receive omalizumab are comparable to those patients with IgE

levels between 30-700 IU/L. A substantial proportion of patients who

initiate omalizumab suspend treatment.

Funding: The William Wagner Research and Education Fund

158 Cost Effectiveness of Multi-Systemic Therapy for Adherencein Adolescents with High Risk Asthma

A. Kujawska, P. Patel, A. Walker, W. Alame, P. Toarmina, S. Naar-King,

D. Ellis, E. Secord; Wayne State University, Children’s Hospital of Mich-

igan, Detroit, MI.

RATIONALE: To determine cost effectiveness of multi-systemic therapy

(MST) for adherence in high-risk asthmatic adolescents.

METHODS: 8 adolescents from our high risk asthma clinic were recruited

for MST because of poor therapy adherence. The in home/community

based intensive adherence therapy was given over a six month period. ER

visits and hospitalizations for each patient at 6 months prior to intervention,

during, and 6 months post therapy were recorded. Analysis via two tailed,

paired t-test was performed.

RESULTS: Total hospitalizations/ER visits for six months preceding MST

intervention was 19 and dropped to 2 during intervention (n 5 8; pre 5 19;

during 5 2; p 5 0.003). Hospitalizations/ER visits at 6 months post

intervention were still significantly lower than baseline (n 5 6; pre 5 13 and

post 5 2; p 5 0.02). The estimated hospitalization/ER cost in one year prior

to MST therapy was $109,380.34. Cost of hospitalizations/ER visits one

year post MST was approximately $11,513.72. Therapist cost for one year

was $22,000.00. Savings per year estimated at $75,866.62 for 8 patients.

CONCLUSIONS: In high-risk asthmatic adolescents MST therapy for

adherence decreases hospitalizations and ER visits significantly and is cost

effective despite intensive nature of therapy.

Funding: Michigan Department of Public Health and Children’s Research

Center of Michigan.

159 Using the Asthma Control Tracker� Web-Based System toMonitor Outcomes and Facilitate Adoption of the AsthmaControl Test� in Ambulatory Asthma Management

C. Dinakar1, J. Portnoy1, D. Lynch1, T. Pendergraft2; 1Children’s Mercy

Hospital/University of Missouri-Kansas City, Kansas city, MO, 2Glaxo

SmithKline, Chapel Hill, NC.

RATIONALE: To describe the implementation of the Partnership for

Asthma Control�, a quality improvement (QI) project to facilitate

adoption of NIH guidelines.

METHODS: Pediatric clinical teams of asthma specialists (n 5 13) and

primary care clinicians (n 5 7) at Children’s Mercy Hospital used the Plan-

Do-Study-Act model to implement the QI project. During patient encoun-

ters, the team used a paper Visit Planner to administer the Asthma Control

Test�, the Childhood Asthma Control Test and to collect other assessments

(FEV1, exhaled nitric oxide, asthma-action plans). The ACT surveys are

validated to quickly assess asthma control in children �12 years (ACT)

and 4-11 years (Childhood ACT). A score of �19 suggests asthma that

may not be as well controlled as it could be. Providers recorded asthma

medications prescribed by class. Data from the Visit Planner were entered

into the Asthma Control Tracker� web-based registry.

RESULTS: Stepwise implementation of the project included systematic

education of providers regarding NIH guidelines, multidisciplinary team

involvement, data management using web-based tracker, and provider-

feedback incentives to encourage participation. Since March 2007, a total

of 612 pediatric asthmatics have been tracked, 522 from asthma specialists

(65% with persistent asthma) and 90 from primary care (53% with

persistent asthma). The mean ACT (n 5 212) and Childhood ACT (n 5

390) scores were 20. Of patients with scores �19, 39% were seen by

specialists, 43% by primary care, and 95% were prescribed controller

medications.

CONCLUSIONS: In the first cycle of this QI project, we have success-

fully implemented adoption of the Partnership for Asthma Control in the

primary and specialty care settings.

160 Pediatric Asthma Management by Resident and AttendingPhysicians in a Suburban Hospital

M. D. Ober, M. Balasubramaniam, D. R. Doshi; William Beaumont

Hospital, Royal Oak, MI.

RATIONALE: In anticipation of the new asthma guidelines (National

Heart Lung Blood Institute, Expert Panel Report III), we developed a

survey to evaluate the consistency of care in patients with asthma between

residents and attending physicians.

METHODS: A blinded questionnaire was distributed to all Pediatric and

Medicine-Pediatric residents, attending physicians in the Pediatric resident

clinic, and community Pediatricians in private practice. The survey

focused on asthma education during clinic visits including: use of written

instructions for mediations, review of inhaler technique, peak flow use, and

distribution of written asthma action plans.

RESULTS: A total of 340 surveys were mailed out to attending physi-

cians, of which, 79 were completed and returned (23.8%). Additionally, 34

surveys were sent to resident physicians, with 18 completed (52.9%). The

majority of all surveyed physicians provided written instructions regarding

medication usage (78% residents, 86% attendings). Inhaler technique was

reviewed by all attending and 76.5% of resident physicians. Peak flow

meters were not consistently recommended (47.1% of residents, 32.9%

attendings). Written asthma action plans were provided by 51.9% of

attending and only 5.6% of resident physicians. Attending physicians tend

to provide written asthma action plans more often than residents (p-value 5

0.0015).

CONCLUSIONS: There is a significant difference in asthma education

provided by attending and resident physicians, most notably the use of

written asthma action plans. Despite these differences, there is ample room

for improvement in providing consistent asthma education in the outpatient

setting.

161 Effects of Different Maintenance Methods of Cone Spacer andPriming Spacer Increasing Doses of Drugs before Use onElectrostatic Charges of Cone Spacer

S. Nanthapisal, M. Vangveeravong; Queen Sirikit National Institute of

Child Health, Bangkok, THAILAND.

RATIONALE: To study effects of maintenance methods of cone spacer

which is Thailand’s product and widely used in Thailand, on electrostatic

charges on surface of spacer. Maintenance methods are cleaning spacer

with water, cleaning spacer with detergent and priming spacer before use

with increasing puffs of each pressurized metered dose inhaler drugs

(Salbutamol, Budesonide, Fluticasone/Salmeterol).

METHODS: Measure and compare electrostatic charges of new cone

spacer, spacer cleaned with water and spacer cleaned with detergent. Then

prime all 3 groups of spacer with increasing doses (2, 4, 6,.20 puffs) of

Salbutamol, Budesonide and Fluticasone/Salmeterol then measure and

compare electrostatic charges after priming each 2 doses of each drug.

RESULTS: Cleaning spacer with detergent decreased electrostatic

charges on spacer better than cleaning with water significantly (p 5

0.038). Each increasing doses of priming of all 3 drugs significantly

changed electrostatic charges on spacer. But priming Budesonide which

is positive charges into new spacers which have negative charges signifi-

cantly increased electrostatic charges on spacers. And also found precipi-

tation of Budesonide aerosol on surface of spacer.

CONCLUSIONS: Cleaning spacer with detergent significantly decreased

amounts of electrostatic charges on spacer and better than rinsing in water.

And there is benefit of priming drug before use only when priming

budesonide more than 20 puffs on new spacer. Cleaning spacer with

detergent is enough to decrease electrostatic charges on spacer.