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Smith MA, Dinh D, Ly NP, Ward SL, McGarry ME, Zinter MS. Changes in the Use of Invasive and Noninvasive Mechanical Ventilation in Pediatric Asthma: 2009-2019. Ann Am Thorac Soc 2023; 20:245-253. [PMID: 36315585 PMCID: PMC9989865 DOI: 10.1513/annalsats.202205-461oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/31/2022] [Indexed: 02/04/2023] Open
Abstract
Rationale: Despite lower overall hospitalization rates for asthma in recent years, there has been an increase in the number of pediatric patients receiving intensive care management in the United States. Objectives: To investigate how the use of invasive and noninvasive mechanical ventilation for asthma has changed in the context of an evolving cohort of critically ill pediatric patients with asthma. Methods: We analyzed children admitted to intensive care units for asthma from 2009 through 2019 in the Virtual Pediatric Systems database. Regression analyses were used to evaluate how respiratory support interventions, mortality, and patient characteristics have changed over time. Odds ratios were calculated to determine how patient characteristics were associated with respiratory support needs. Stratified analyses were performed to determine how changing practice patterns may have differed between patient subgroups. Results: There were 67,614 admissions for 56,727 patients analyzed. Intubation occurred in 4.6% of admissions and decreased from 6.9% to 3.4% over time (P < 0.001), whereas noninvasive ventilation as the maximal respiratory support increased from 8.9% to 20.0% (P < 0.001). Over time, the cohort shifted to include more 2- to 6-year-olds and patients of Asian/Pacific Islander or Hispanic race/ethnicity. Although intubation decreased and noninvasive ventilation increased in all subgroups, the changes were most pronounced in the youngest patients and slightly less pronounced for obese patients. Conclusions: In pediatric asthma, use of intubation has halved, whereas use of noninvasive ventilation has more than doubled. This change in practice appears partially related to a younger patient cohort, although other factors merit exploration.
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Affiliation(s)
| | - Doantrang Dinh
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Ngoc P. Ly
- Division of Pulmonology, Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California; and
| | | | - Meghan E. McGarry
- Division of Pulmonology, Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California; and
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Redmond C, Akinoso-Imran AQ, Heaney LG, Sheikh A, Kee F, Busby J. Socioeconomic disparities in asthma health care utilization, exacerbations, and mortality: A systematic review and meta-analysis. J Allergy Clin Immunol 2021; 149:1617-1627. [PMID: 34673047 DOI: 10.1016/j.jaci.2021.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior studies investigating the effect of socioeconomic status (SES) on asthma health care outcomes have been heterogeneous in the populations studied and methodologies used. OBJECTIVE We sought to systematically synthesize evidence investigating the impact of SES on asthma health care utilization, exacerbations, and mortality. METHODS We searched Embase, Medline, and Web of Science for studies reporting differences in primary care attendance, exacerbations, emergency department attendance, hospitalization, ventilation/intubation, readmission, and asthma mortality by SES. Study quality was assessed using the Newcastle Ottawa Scale, and meta-analyses were conducted using random-effects models. We conducted several prespecified subgroup analyses, including by health care system (insurance based vs universal government funded) and time period (before vs after 2010). RESULTS A total of 61 studies, comprising 1,145,704 patients, were included. Lower SES was consistently associated with increased secondary health care utilization including emergency department attendance (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.40-1.84), hospitalization (OR, 1.63; 95% CI, 1.34-1.99), and readmission (OR, 1.31; 95% CI, 1.19-1.44). Substantial associations were also found between SES and ventilation/intubation (OR, 1.76; 95% CI, 1.13-2.73), although there was no association with primary care attendances (OR, 0.79; 95% CI, 0.51-1.24). We found evidence of borderline significance for increased exacerbations (OR, 1.18; 95% CI, 0.98-1.42) and mortality (OR, 1.12; 95% CI, 0.92-1.37) among more deprived groups. There was no convincing evidence that disparities were associated with country-level health care funding models or that disparities have narrowed over time. CONCLUSIONS Patients with a lower SES have substantially increased secondary care health care utilization. We found evidence suggestive of increased exacerbations and mortality risk, although CIs were wide. These disparities have been consistently reported worldwide, including within countries offering universally funded health care systems. Systematic review registration: CRD42020173544.
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Affiliation(s)
- Charlene Redmond
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Abdul Qadr Akinoso-Imran
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Liam G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom.
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3
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Glick AF, Tomopoulos S, Fierman AH, Trasande L. Disparities in Mortality and Morbidity in Pediatric Asthma Hospitalizations, 2007 to 2011. Acad Pediatr 2016; 16:430-437. [PMID: 26768727 PMCID: PMC10843839 DOI: 10.1016/j.acap.2015.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/27/2015] [Accepted: 12/30/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Asthma is a leading cause of pediatric admissions. Although several factors including race have been linked to increased overall asthma morbidity and mortality, few studies have explored factors associated with inpatient asthma outcomes. We examined factors associated with mortality and morbidity in children admitted for asthma. METHODS Data were obtained from the US Nationwide Inpatient Sample for 2007 to 2011. Patients 2 to 18 years old with a primary diagnosis of asthma were included. Predictor variables were sociodemographic and hospital factors and acute/chronic secondary diagnoses. Outcomes were mortality, intubation, length of stay (LOS), and costs. Weighted national estimates were calculated. Multivariable analyses were performed. RESULTS There were 97,379 (478,546 weighted) asthma admissions. Most patients were male (60.6%); 30% were white, 28% black, and 18% Hispanic. Mortality rate was 0.03%, and 0.3% were intubated. Median LOS was 2 (interquartile range, 1-3) days. Median costs were $2,950 (interquartile range, $1990-$4610). Native American race, older age (13-18 years), and West region were significant independent predictors of mortality. Intubation rate was lower in Hispanic compared with white children (P = .028). LOS was shorter in Asian compared with white children (P = .022) but longer in children with public insurance and from low income areas (P < .001). Average costs were higher in black, Hispanic, and Asian compared with white children (P < .05). CONCLUSIONS With the exception of Native Americans, race/ethnicity is not associated with inpatient asthma mortality and has varied effects on morbidity. Recognition of factors associated with increased asthma mortality and morbidity might allow for earlier, more effective treatment and avoidance of complications.
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Affiliation(s)
- Alexander F Glick
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York.
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York
| | - Arthur H Fierman
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York
| | - Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York; Departments of Environmental Medicine and Population Health, New York University School of Medicine, New York; New York University Wagner School of Public Service, New York; Department of Nutrition, Food & Public Health, New York University Steinhardt School of Culture, Education, and Human Development, New York; New York University Global Institute of Public Health, New York
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4
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Abstract
Emotional/behavioral difficulties (EBDs) are increasingly diagnosed in children, constituting some of the most common chronic childhood conditions. Left untreated, EBDs pose long-term individual and population-level consequences. There is a growing evidence of disparities in EBD prevalence by various demographic characteristics. This article builds on this research by examining disparities in access to medical care for children with EBD. From 2008 to 2011, using data from the US National Health Interview Survey (N = 31,631) on sample children aged 4-17, we investigate (1) whether having EBD affects access to care (modeled as delayed care due to cost and difficulty making an appointment) and (2) the role demographic characteristics, health insurance coverage, and frequency of service use play in access to care for children with EBD. Results indicate that children with EBD experience issues in accessing care at more than twice the rate of children without EBD, even though they are less likely to be uninsured than their counterparts without EBD. In multivariable models, children with EBD are still more likely to experience delayed care due to cost and difficulty making a timely appointment, even after adjusting for frequency of health service use, insurance coverage, and demographic characteristics.
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Affiliation(s)
- Carrie Henning-Smith
- University of Minnesota School of Public Health – Division of Health Policy and Management
| | - Sirry Alang
- University of Minnesota School of Public Health – Division of Health Policy and Management
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5
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Yatsenko O, Pizano J, Nikolaidis A. Revisiting maternal–infant bonding’s effects on asthma: A brief history. COGENT PSYCHOLOGY 2016. [DOI: 10.1080/23311908.2016.1161267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Olga Yatsenko
- Department of Neurodevelopmental Research, Porter Pediatric and Adolescent Associates, Porter, TX, USA
| | - Joseph Pizano
- Department of Neurodevelopmental Research, Porter Pediatric and Adolescent Associates, Porter, TX, USA
| | - Andreas Nikolaidis
- Department of Neurodevelopmental Research, Porter Pediatric and Adolescent Associates, Porter, TX, USA
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6
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Strong C, Chang LY. Family socioeconomic status, household tobacco smoke, and asthma attack among children below 12 years of age: gender differences. J Child Health Care 2014; 18:388-98. [PMID: 23908368 DOI: 10.1177/1367493513496672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Studies have demonstrated the negative impact of environmental tobacco smoke (ETS) or parental cigarette smoking on pediatric asthma. Little is known, however, regarding whether there is a gender difference in the effect of household ETS on pediatric asthma. Using a nationwide survey in Taiwan, we examined the relationship between asthma prevalence in the past year and household ETS among children below 12 years of age (N = 3761). We used multivariate regression models to assess odds ratios (ORs) and 95% confidence intervals (CIs) for the association of household ETS and asthma attacks by gender. In about 3% of the sample, parents reported that their children had an asthma attack in the past year, confirmed by physicians. Multivariate logistic regression revealed that household ETS predicted asthma attacks for girls (OR = 3.11, 95%CI = 1.24-7.76) but not for boys. Father's education was significantly associated with asthma attack for both girls (OR = 1.24, 95%CI = 1.04-1.47) and boys (OR = 1.15, 95%CI = 1.05-1.26). Girls with lower family income were more likely to have had an asthma attack in the last year (OR = .48, 95%CI = .27-.87). The impact of household ETS and family socioeconomic status on asthma attacks differs by gender among children below 12 years.
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7
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Mehta NK, Lee H, Ylitalo KR. Child health in the United States: recent trends in racial/ethnic disparities. Soc Sci Med 2013; 95:6-15. [PMID: 23034508 PMCID: PMC4374424 DOI: 10.1016/j.socscimed.2012.09.011] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 08/09/2012] [Accepted: 09/10/2012] [Indexed: 01/13/2023]
Abstract
In the United States, race and ethnicity are considered key social determinants of health because of their enduring association with social and economic opportunities and resources. An important policy and research concern is whether the U.S. is making progress toward reducing racial/ethnic inequalities in health. While race/ethnic disparities in infant and adult outcomes are well documented, less is known about patterns and trends by race/ethnicity among children. Our objective was to determine the patterns of and progress toward reducing racial/ethnic disparities in child health. Using nationally representative data from 1998 to 2009, we assessed 17 indicators of child health, including overall health status, disability, measures of specific illnesses, and indicators of the social and economic consequences of illnesses. We examined disparities across five race/ethnic groups (non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic Asian, and non-Hispanic other). We found important racial/ethnic disparities across nearly all of the indicators of health we examined, adjusting for socioeconomic status, nativity, and access to health care. Importantly, we found little evidence that racial/ethnic disparities in child health have changed over time. In fact, for certain illnesses such as asthma, black-white disparities grew significantly larger over time. In general, black children had the highest reported prevalence across the health indicators and Asian children had the lowest reported prevalence. Hispanic children tended to be more similar to whites compared to the other race/ethnic groups, but there was considerable variability in their relative standing.
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Affiliation(s)
- Neil K Mehta
- Emory University, 1518 Clifton Road, CNR 7035, Atlanta, GA 30322, USA.
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Powell PW, Chen R, Kumar A, Streisand R, Holmes CS. Sociodemographic effects on biological, disease care, and diabetes knowledge factors in youth with type 1 diabetes. J Child Health Care 2013. [PMID: 23197386 DOI: 10.1177/1367493512456105] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sociodemographic risk factors place youth with type 1 diabetes at higher risk for immediate and long-term health complications, yet research has still to disentangle the confounding effects of ethnicity, socioeconomic status (SES), and parental marital status. Group-oriented and variable-oriented analyses were conducted to investigate sociodemographic differences in biological, disease care, and diabetes knowledge factors in youth with type 1 diabetes. The sample included 349 youth, age 9-17 years (79.9% Caucasian, 71.3% lived with two biological parents, M SES = 46.24). Group t-tests confirmed commonly reported ethnic differences in HbA1c and disease care behaviors. However, variable-oriented analyses controlling for confounding sociodemographic influences showed most disease care effects attributed to ethnicity were better explained by SES. Results may inform development of diabetes literacy programs that integrate culturally sensitive lifestyle and language components for families of youth at risk of poor metabolic control.
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Affiliation(s)
- Priscilla W Powell
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284-2018, USA
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Coutinho MT, McQuaid EL, Koinis-Mitchell D. Contextual and cultural risks and their association with family asthma management in urban children. J Child Health Care 2013; 17:138-52. [PMID: 23455872 DOI: 10.1177/1367493512456109] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines the association between caregivers' perceptions of home and neighborhood safety on family asthma management in the context of cultural risk factors (e.g., discrimination and acculturative stress) in a sample of urban and ethnic minority families. Participants included 147 children (ages 6-13) and their primary caregiver from Latino, African American and Non-Latino White (NLW) backgrounds. When controlling for poverty, caregivers' perceptions of home and neighborhood safety predicted family asthma management for the overall sample and for the NLW families. Additionally, for caregivers who endorsed higher levels of perceived discrimination, home and neighborhood safety predicted family asthma management. This study demonstrates the utility of considering caregivers' perceptions of home and neighborhood safety when examining urban families' day-to-day engagement with asthma management tasks.
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10
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Bois C, Guillemot G. [Social inequalities in health in 4 year-old children in the Hauts-de-Seine (France)]. Rev Epidemiol Sante Publique 2013; 61 Suppl 2:S47-59. [PMID: 23684857 DOI: 10.1016/j.respe.2013.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The social effects on health described in France on newborn and 5- to 6-year-old children suggest the existence of a social gradient among the youngest children. The favoured, though unequal, social situation of the department of the Hauts-de-Seine (France), makes it particularly adapted to this study. A survey, conducted in 2010 by the departmental service of maternal and infantile protection (PMI) on a representative sample of 1227 children, who received check-ups in their first or second year of nursery school, reveals a significant increase of overweight (from 4.6 to 16.5%), of language disorders (from 8.3 to 25.3%), of the orientations to specialized consultations (from 20.6 to 36.6%), according to the socioprofessional category of the father or the social affiliation of the children in the following subgroups: children speaking or understanding a foreign language (36.6% of the sample), children schooled in priority educational zones (equivalent to education achievement zones in UK, 13.6%), children with limited social health coverage (13.4%). In contrast, the BCG and hepatitis B vaccinal coverage is systematically higher in these various groups. The multivariate analysis investigates for each health problem its links with these various subgroups, and with previous child care experiences, and PMI medical consultations. This study suggests therefore further prospects for different actions according to health problems or regarding vaccinal strategy. The development of such routine indicators of disadvantage should allow territorial health services to target their actions towards the decrease of social disparities in health and to check a posteriori the efficiency of the public systems, which have been implemented.
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Affiliation(s)
- C Bois
- Service départemental de protection maternelle et infantile, Conseil général des Hauts-de-Seine, 16 boulevard Jacques-Germain-Soufflot, Nanterre, France.
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Bråbäck L, Ekéus C, Lowe AJ, Hjern A. Confounding with familial determinants affects the association between mode of delivery and childhood asthma medication - a national cohort study. Allergy Asthma Clin Immunol 2013; 9:14. [PMID: 23590822 PMCID: PMC3643829 DOI: 10.1186/1710-1492-9-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 03/06/2013] [Indexed: 11/10/2022] Open
Abstract
Background Mode of delivery may affect the risk of asthma but the findings have not been consistent and factors shared by siblings may confound the associations in previous studies. Methods The association between mode of delivery and dispensed inhaled corticosteroid (ICS) (a marker of asthma) was examined in a register based national cohort (n=199 837). A cohort analysis of all first born children aged 2-5 and 6-9 years was performed. An age-matched sibling-pair analysis was also performed to account for shared genetic and environmental risk factors. Results Analyses of first-borns demonstrated that elective caesarean section was associated with an increased risk of dispensed ICS in both 2-5 (adjusted odds ratio (aOR)=1.19, 95% confidence interval (CI) 1.09-1.29) and 6-9 (aOR=1.21, 1.09-1.34) age groups. In the sibling-pair analysis, the increased risk associated with elective caesarean section was confirmed in 2-5 year olds (aOR=1.22, 1.05-1.43) but not in 6-9 year olds (aOR=1.06, 0.78-1.44). Emergency caesarean section and vacuum extraction had some association with dispensed ICS in the analyses of first-borns but these associations were not confirmed in the sibling-pair analyses. Conclusions Confounding by familial factors affects the association between mode of delivery and dispensed ICS. Despite this confounding, there was some evidence that elective caesarean section contributed to a modestly increased risk of dispensed ICS but only up to five years of age.
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Affiliation(s)
- Lennart Bråbäck
- Occupational & Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; Department of Research and Development, Västernorrland County Council, Sundsvall, Sweden ; Department of Research and Development, Sundsvalls sjukhus, Sundsvall, SE 85186, Sweden
| | - Cecilia Ekéus
- Department of Women's and Children's Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden
| | - Adrian J Lowe
- Occupational & Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; Murdoch Childrens Research Institute, Melbourne, Australia ; Centre for MEGA Epidemiology , School of Population Health, The University of Melbourne, Melbourne, Australia
| | - Anders Hjern
- Centre for Health Equity Studies (CHESS), Karolinska Institutet/Stockholm University, Stockholm, Sweden ; Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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12
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Crespo NC, Ayala GX, Vercammen-Grandjean CD, Slymen DJ, Elder JP. Socio-demographic disparities of childhood asthma. J Child Health Care 2011; 15:358-69. [PMID: 21996682 DOI: 10.1177/1367493510397680] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Childhood asthma is particularly prevalent among disadvantaged children and is associated with greater functional consequences. This study described factors associated with childhood asthma in a sample of Latino and non-Latino children. Data were from baseline measures of 791 parent and child dyads involved in a childhood obesity prevention study. Parents completed a self-administered survey assessing childhood factors, demographics, acculturation and child asthma diagnosis. Multivariate mixed effects logistic regression analyses tested for correlates of child asthma and ethnicity interactions. Children were 4-10 years old, half were female, 86.0 percent were US-born and 45.7 percent were overweight or obese. The prevalence of childhood asthma was 11.5 percent. In multivariate analyses, the odds of childhood asthma were greater among children of non-Latino descent (OR = 4.1, CI: 1.8, 9.2), who had health insurance (OR = 11.1, CI: 2.7, 46.4), were male (OR = 1.8; CI: 1.1, 3.1) and born pre-term (OR = 3.0, CI: 1.4, 6.3). This study supports socio-demographic disparities in childhood asthma and evidence of their independent effects.
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Affiliation(s)
- Noe C Crespo
- Institute for Behavioral and Community Health (IBACH), Graduate School of Public Health, San Diego State University, San Diego, CA 92123, USA.
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13
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Klein M, Vaughn LM, Baker RC, Taylor T. Welcome back? Frequent attenders to a pediatric primary care center. J Child Health Care 2011; 15:175-86. [PMID: 21828169 DOI: 10.1177/1367493511404721] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines frequent attenders of a pediatric primary care clinic at a large urban children's hospital--who they are and their reasons for frequent attendance to the clinic. The literature suggests that some visits by frequent attenders may not be medically necessary, and these additional appointments may impair others' access to medical care within the same system. The key to eliminating excessive primary care visits is to determine if it is a problem in the primary care practice (quantify the problem), explore the reasons for the visits (from the patients' perspective), and then provide educational interventions that address the various causes for the extra visits and encourage the use of available resources, either ancillary services in the practice itself or resources and agencies available in the community (e.g. social service, legal aid).
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Affiliation(s)
- Melissa Klein
- Cincinnati Children's Hospital Medical Center, General & Community Pediatrics, Cincinnati, OH 45229, USA.
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Cataletto Guest Editor M. Commentary: The Importance of Certified Asthma Educators in Promoting Health Literacy for Children with Asthma and Their Families. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2011; 24:127-128. [PMID: 35927874 DOI: 10.1089/ped.2011.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Mary Cataletto Guest Editor
- Division of Pediatric Pulmonology, Winthrop University Hospital, Mineola, New York
- Member, National Asthma Educator Certification Board, Grand Rapids, Michigan
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