Interventions for educating children who are at risk of asthma-related emergency department attendance

 

Abstract

Background

Asthma is the most common chronic childhood illness and is a leading cause for paediatric admission to hospital. Asthma management for children results in substantial costs. There is evidence to suggest that hospital admissions could be reduced with effective education for parents and children about asthma and its management.

Objectives

To conduct a systematic review of the literature and update the previous review as to whether asthma education leads to improved health outcomes in children who have attended the emergency room for asthma.

Search methods

We searched the Cochrane Airways Group Trials Register, including the MEDLINE, EMBASE and CINAHL databases, and reference lists of trials and review articles (last search May 2008).

Selection criteria

We included randomised controlled trials of asthma education for children who had attended the emergency department for asthma, with or without hospitalisation, within the previous 12 months.

Data collection and analysis

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We pooled dichotomous data with a fixed-effect risk ratio. We used a random-effects risk ratio for sensitivity analysis of heterogenous data.

Main results

A total of 38 studies involving 7843 children were included. Following educational intervention delivered to children, their parents or both, there was a significantly reduced risk of subsequent emergency department visits (RR 0.73, 95% CI 0.65 to 0.81, N = 3008) and hospital admissions (RR 0.79, 95% CI 0.69 to 0.92, N = 4019) compared with control. There were also fewer unscheduled doctor visits (RR 0.68, 95% CI 0.57 to 0.81, N = 1009). Very few data were available for other outcomes (FEV1, PEF, rescue medication use, quality of life or symptoms) and there was no statistically significant difference between education and control.

Authors' conclusions

Asthma education aimed at children and their carers who present to the emergency department for acute exacerbations can result in lower risk of future emergency department presentation and hospital admission. There remains uncertainty as to the long-term effect of education on other markers of asthma morbidity such as quality of life, symptoms and lung function. It remains unclear as to what type, duration and intensity of educational packages are the most effective in reducing acute care utilisation.

 

Plain language summary

What are the effects of educational interventions delivered to children and/or their families, who have experienced an emergency department visit with their asthma within the previous 12 months?

Asthma care for children in our society is common and costly. There is now evidence that educational intervention for children who have attended the emergency department for asthma lowers the risk of the need for future emergency department visits and hospital admissions. This review looked at studies which compared usual care for asthma to more intensive educational programmes and the results showed a statistically significant reduction in the treatment groups needing subsequent emergency department visits or hospital admissions. We were not able to determine the most effective type, duration or intensity of education that should be offered to children to offer the best asthma outcomes.

 

摘要

背景

針對有因為氣喘發作而至急診就醫之風險的兒童介入教育

氣喘是最常見的慢性兒童疾病,而且是兒童住院的主因，因此兒童氣喘的處置耗費許多醫療支出，有證據顯示有效的教育父母和兒童相關氣喘的處置可以降低住院率。

目標

藉由系統性的文獻回顧及更新以前的文章，來評估氣喘衛教是否可以改善兒童因氣喘至急診就醫的情形。

搜尋策略

我們搜尋了2008年五月以前的 Cochrane Airways Group Trials Register(包括 MEDLINE, EMBASE和CINAHL資料庫)以及相關的參考資料和文章回顧

選擇標準

我們選取的文章是隨機對照研究，關於最近12個月內因為氣喘至急診就醫兒童的氣喘衛教

資料收集與分析

由兩位作者獨立的分析這些研究的品質與資料，並向研究者收集其他的資訊，我們把單純二分法的資料做整合性的分析(使用 fixedeffect risk ratio)，另外對於歧異性較大的資料也做敏感度的分析(使用 randomeffects risk ratio)。

主要結論

總共蒐集38個研究共7843位兒童,對於兒童,父母或是兩者進行氣喘衛教可以顯著的減少急診就醫次數(RR 0.73, 95% CI 0.65 to 0.81, N = 3008)和住院率(RR 0.79, 95% CI 0.69 to 0.92, N = 4019)，此外，非計畫性看診次數也減少(RR 0.68, 95% CI 0.57 to 0.81, N = 1009)，至於其他 FEV1, PEF, 急救藥物的使用以及生活品質的改善，現有的資料很少且衛教與對照兩組沒有統計上顯著的差異。

作者結論

對於因為氣喘急性發作的兒童和他們的照顧者進行氣喘衛教，可以減少未來急診和住院的風險，但是其他長期的生活品質和肺功能的影響卻仍然不確定，而且對於哪一種衛教方式和衛教時間長短與強度能最有效降低急性照護的資源利用也不太清楚。

翻譯人

本摘要由臺北榮民總醫院李國瑋翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

孩童的氣喘照顧對於我們的社會是常見且醫療費用龐大的,目前的證據顯示,對於因氣喘去急診的兒童進行衛生教育,可以減少之後去急診和住院的機率,這篇回顧研究了從平常的氣喘照顧到密集的教育計畫,結果顯示可以顯著的減少去急診和住院的機率,不過對於哪一種方式,期間和密集程度的衛教育對於氣喘的預後有最大的效果，目前的研究並無法得知。