1. The Impact of Asthma Education CHKV Medical Mission 2011 By Jo-Anne St. Vincent Jo-Anne St. Vincent

2. Objectives To share our experience with childhood asthma in Winnipeg, CanadaTo share our experience with childhood asthma in Winnipeg, Canada To describe some strategies to decrease the impact of asthma on hospital admissionsTo describe some strategies to decrease the impact of asthma on hospital admissions To describe the impact of various educational strategies related to asthmaTo describe the impact of various educational strategies related to asthma

3. Impact of Asthma Most common chronic disease causing children to miss school, visit the Emergency department (ED) & to be admitted to hospitalMost common chronic disease causing children to miss school, visit the Emergency department (ED) & to be admitted to hospital Rates highest in Westernized countries but increasing worldwide. (GINA : Global Initiative for Asthma 2010)Rates highest in Westernized countries but increasing worldwide. (GINA : Global Initiative for Asthma 2010) 12% of Canadian children12% of Canadian children Interferes with child & caregiver quality of lifeInterferes with child & caregiver quality of life Affects caregiver work productivityAffects caregiver work productivity Health care costsHealth care costs

4. Impact of asthma at Children’s Hospital in 1997 3500 Emergency Room visits per year3500 Emergency Room visits per year 400-500 hospitalizations for asthma per year400-500 hospitalizations for asthma per year

5. 2010 Chronic systemic inflammatory disease. Exacerbations lead to airway remodelling Evolution of understanding of asthma

6. Asthma Education “Education is an essential component of asthma therapy and should be offered to all patients”. (Pediatric Asthma Consensus Guidelines, 2003)“Education is an essential component of asthma therapy and should be offered to all patients”. (Pediatric Asthma Consensus Guidelines, 2003) Education is more than providing information.Education is more than providing information.

7. Strategies: Development of “The Children’s Asthma Education Centre” (2007)Development of “The Children’s Asthma Education Centre” (2007) Goals:  ER admissionGoals:  ER admission  Hospital admissions  School absenteeism  Work absenteeism for parents  Use of asthma controller medication  Quality of life for children and families

8. The Children’s Asthma Education Centre Target audience: Primarily parents and children with asthma seen in our: Emergency room Admitted to hospital

9. 1 in 3 asthma patients had no intention of filling their maintenance medicine Asthma Society of Canada: State of the Asthma Nation, Nov, 2006 1 in 5 asthma patients who did fill their maintenance medicine did not take it

10. Education is not Just Information  Addressing beliefs, attitudes, values, knowledge  Increasing access to medications  Understanding when asthma is well controlled and when it is worsening  Encouraging behavior change

11. Asthma Education Instructors are Certified Asthma EducatorsInstructors are Certified Asthma Educators Individual sessions:Individual sessions: All children admitted to hospital one hour consultation before discharge Families with special needs such as language barrier, learning difficulties

12. Small Group Asthma Education – encouragedSmall Group Asthma Education – encouraged Groups consist of:Groups consist of: –Parents of children 0-6 years of age –Parent AND children age 7-11 years –Teens ages 12-16 years Sessions are designed to be interactive following principles of adult and child education

13. Topics of small group sessions Basic physiology – lung and asthmaBasic physiology – lung and asthma Symptoms of asthma, good controlSymptoms of asthma, good control Recognizing worsening asthma earlyRecognizing worsening asthma early Avoiding provoking factors – smoking, petsAvoiding provoking factors – smoking, pets Medication – how to use inhalersMedication – how to use inhalers Action Plan – adjusting medications at homeAction Plan – adjusting medications at home

14. Asthma Action Plan Written Plan Written Plan Completed by the doctor Completed by the doctor Allows patient to Allows patient to evaluate own asthma and change treatment based on asthma control

15. Outcomes Children/families who attended small group asthma education had (all with p<0.05):Children/families who attended small group asthma education had (all with p<0.05): –Fewer Emergency Room visits –Fewer courses of oral corticosteroids –Improved Quality of Life scores –Improved Activity Level –Parents missed fewer days of work Small-group, interactive education and the effect on asthma control by children and their families. Wade T.A. Watson et al, CMAJ Aug 17, 2009Small-group, interactive education and the effect on asthma control by children and their families. Wade T.A. Watson et al, CMAJ Aug 17, 2009

16. Children who attended asthma education required fewer visits to the Emergency Room for asthma.

17. Children were more likely to use controller medication as prescribed following an asthma education program

18. Children who attended asthma education higher quality of life of life scores

19. Parents who attended asthma education missed significantly less work due to their child’s asthma

20. Children who attended the program showed improved lung function one year after enrollment.Children who attended the program showed improved lung function one year after enrollment.

21. Strategy: Pediatric Inpatient Asthma Care Map Evidence based map created byEvidence based map created by multidisciplinary team multidisciplinary team Goals:Goals: –Decrease length of stay in ER –Increase use of spirometry –Increase referrals to Asthma Education –Increase written asthma discharge plans

22. Outcomes: Care is being delivered in a timely fashionCare is being delivered in a timely fashion Care is consistentCare is consistent Oral corticosteroids being delivered within an hour of triage 92% of the timeOral corticosteroids being delivered within an hour of triage 92% of the time Decreased admissions to hospitalsDecreased admissions to hospitals Decreased length of stay in ER and HospitalDecreased length of stay in ER and Hospital Patients have written action plan for asthma management at homePatients have written action plan for asthma management at home

23. Other Strategies School based asthma education programsSchool based asthma education programs –For children who do not access the Centre Education of Health Professionals in rural communitiesEducation of Health Professionals in rural communities Education of hospital staffEducation of hospital staff WebsiteWebsite Information pamphletsInformation pamphlets

24. Children's Hospital Asthma Admissions 1993-2003 2010

25. Impact of Asthma at Children’s Hospital 1997 3500 Emergency Room visits3500 Emergency Room visits 400-500 hospitalizations for asthma400-500 hospitalizations for asthma 2009 1300 Emergency Room visits1300 Emergency Room visits 163 hospitalizations for asthma163 hospitalizations for asthma Decrease in ER and hospital admissions noted across Canada but higher at Children’s Hospital in Winnipeg.

26. Patients who understand their disease have improved quality of life and less illnessPatients who understand their disease have improved quality of life and less illness Patient education decreases episodes of acute illnessPatient education decreases episodes of acute illness Staff education leads to improved patient careStaff education leads to improved patient care Summary

27. Questions?