pediatric asthma management by resident and attending physicians in a suburban hospital
TRANSCRIPT
J ALLERGY CLIN IMMUNOL
VOLUME 121, NUMBER 2
Abstracts S41
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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.