Barriers to Asthma Management

Barriers to Asthma ManagementRenate Jimerson, Pat LeBlanc, Centrella StacksAsthmaAsthma, the most common chronic unwellness of childhood, is an inflammatory disease characterized by hyper responsiveness of the airways to stimuli and reversible airway obstruction (Janson, 1998). According to the American Lung Association (ALA) it affects between 6.7 and 9.6 million U.S. children under the age of 18, American Lung Association (ALA) (as cited in Toole 2013). Asthma is the most common chronic childhood disease with increase prevalence from 31.4 per 1000 state in 1980 to 54.6 per 1000 population in 2000 despite the advances in bronchial asthma pathophysiology understanding and treatment (Tsakiris, Iordanidou, Paraskakis, Talskidis, Rigas, Zimeras, Katsardis, Chatzimichael, 2013).Although there name been new practice of medicines and medical advances, asthma is a significant cause of a morbidity, groom absenteeism, parent lost work days, emergency department (ED) visits, and hospita lizations for children all(prenominal) over the world. Brown, Gallagher, Fowler, Wales Martinez Mattke, Martorell, Sharma, Malveaux, Lurie (as cited in Toole 2013). Looking into the causes of school absenteeism, it has been found that asthma is the most rat cause, according to Doull et al., 55% of school students and 55% of asthmatic students missed school days due to respiratory symptoms. Attendance and the limitation of daily activities are some(prenominal) used as indicators of asthma control level in children. Increased absenteeism interrupts learning processes and participation in daily activities.Unfortunately In a learning that specifically focused on parents report of receiving written self-management tools from pediatric primary care physicians, Cabana et al. (8) found that only about 30% of parents reported receiving these tools known to still childrens medical bond. (Orrell-Valente, Jvirtuosos, Manasse, Thyne, Shenkin, Cabana (2011).An initial literature review w as done to gain information about what barriers impact medicament compliance with school age children. employ different keywords children, medicinal drug compliance, asthma, hail, education, barriers and impact of noncompliance were used in the CINAHL database, Google Search, and the Simmons Library to locate information on the subject. Further searches were conducted to refine the topic, from medication compliance with school age children to a more(prenominal) specific topic of medication compliance and asthmatic children.Identifying asthma as the main subject allowed for us to move in a more specific direction. Our next pursuit was in identifying and categorizing the different barriers, determining the major and minor subjects and listing them under specific categories. No one attempt part is responsible for asthma morbidity rather a plethora of factors contribute to the high prevalence, which vary dramatically among children with asthma (Clark, Mitchell, Rand, 2009). Asthm a risk factors include living in poverty in the inner-city, being uninsured or Medicaid enrolled, and being African American or Hispanic (Akinbami, Moorman, Garbe, Sondik, 2009 Bloomber et al., 2009 Gerald et al. Liu Pearlman, 2009 Mattke et al., 2009 Smith, 2009) (Toole, 2013 p 115).In 2005, 9% of children under the age of 14 years were diagnosed with asthma and the prevalence of asthma was found to be highest in this age group (Center for Disease declare and Prevention, Control and Prevention, 2006). (Kamps, J. L., Rapoff, M. A., Roberts, M. C., Varela, R. E. Barnard, M., Olson, N., 2008 p. 206).Critiquing the research articles that were found has led to three major barriers in asthma management. The first barrier is in cost. Subcategories of cost include insurance availability, income, and socio sparing levels. The second is culture. Subcategories of culture include language barriers, legal status, traditions and use of alternative medicine. The last is education. Subcategori es of education include health literacy, education level, reading and comprehension abilities, information provided and follow up.Barriers that impact and interfere with the management of asthma in children are varied. The outcome of in in effect(p) management are increase cost, hospitalizations, improper use of medication and death. Health care providers need to ensure that the patient and parent or guardian understand the proper use of medication, the disease process and associated risk for contumely of medication. Using these categories, a literature review will be a guide in determining the best practice for improving outcomes, decreasing cost, and development a plan to ensure cooperation between parents, children and the health care provider.Asthma management requires a multi-faceted approach, including an effective educational component (Ambulatory Pediatrics, 2006). Poor patient outcomes have been associated with a lack of patient and parent compliance with the patients ind ividualized treatment plan. There are a number of possible factors that may play a role in patients and parents noncompliance. They include financial and cultural barriers, and parents and patients misconception about the disease process and the importance of treatment (Cleveland, 2013). The trends reported in a recent study indicated that asthma education to parents positively impacts asthma-related outcomes in children (Kielb, Lin, Hwang, 2007). In this small sample, there was a decrease in asthma-related sick visits post-education.Asthma cost are increasing and responsible for a higher percentage of the total health care cost for treatment. Increasing and changing copayment are leading to more emergency room visits and hospitalizations. The cost of these are not as visible as the direct cost of an inhaler medications. So the need for educating on all the cost of asthma are important.In the article Outpatient Management of Asthma in Children by Andre Schultz and Andrew C. Martin , they discuss the roles of the provider in the diagnosis and treatment of asthma in children. This article determined that one of the critical areas is non adherence to treatment. Having a plan in place is important as well as keep follow up, avoidance of triggers, and use of medication. Non adherence to medication is impacted by the several factors. Socioeconomic status plays a large role in adherence to medication. Data obtained shows that lower adherence is reported in children at a higher rate from low income families.Perception of cost and the discussion between the practician and patients is important. Determining how the client feels about the medication, treatment plan and chronic disease is important. This will help to facilitate the response to care. The perception of the cost of medication on the client will play a significant role. Not discussing these important facts with the clients may lead to non-compliance. (Patel, M. R., Coffman, J. M., Tseng, Chien-Wen, Clark, N . M. and Cabana, M. D.).In a quasi-experimental study done in 2010, they compared participants in a control and intervention group in regards to adherence to medication, healthcare cost and resource utilization. The determined intervention consisted of 2 components. One an average decrement in copayment and the second was mailing educational material for asthma management. Adherence was determine by the medication available during the duration of therapy and total supply of medication divided by the duration of therapy. When refills overlapped, it was assumed that the client consumed all medications. Healthcare resource was determined by office visits, hospitalizations, emergency room visit, short acting beta-agonist canisters and oral corticosteroid prescriptions. Cost were defined as total amount paid for visits, hospitalizations, emergency room visits, and prescription drugs. Overall cost were determined during the dozen month follow up period. Monthly cost were used rather th an total cost during the study period. This study showed improved adherence to controller medication which translated into reduced medical cost and increased prescription cost. Although there were an increase in prescription cost the overall expenditure decreased. This study determined that increasing copayments will create a financial barrier to medication adherence. (DSouza, A., Rahnama, R., Regan, T., Common, B., Burch, S. (2010).Understanding that noncompliance to medication comes from the perspective of the client. In children, parents are the main administers of medication. A have-to doe with between the socioeconomics, cultural values, education and use of medication has been shown to produce a negative effect on adherence. This effect is not a single factor but many factors grouped together to provide a complete picture. Clearly identifying the factors that influence compliance with clients will ensure a more effective management in children with asthma.ReferencesBloomberg , G. R., Banister, C., Sterkel, R., Epstein, J., Bruns, J., Swerczek, L., et al. (2009). Socioeconomic, family, and pediatric practice factors that affect level of asthma control. Pediatrics, 123(3), 829-835.Brooten, D., Youngblut, J. M., Royal, S., Cohn, S., Lobar, S. L., Hernandez, L. (2008). Outcomes of an asthma program Healthy children, healthy homes. Pediatric Nursing, 34(6), 448-455.Clayton, S. (2014). Adherence to asthma medication. restrain Prescribing, 12(2), 68-74.Cleveland, K.K. (2013). Evidence-based Asthma Education for Parents. daybook for Specialists in Pediatric Nursing, 18(1), 25-32. doi 10.111/jspn.12007Cloutier, M., Jones, G., Hinckson, V., Wakefield, D. (2008). Effectiveness of an Asthma Management Program in Reducing Disparities of Care in urban Children. 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