Increasing the child and family-centeredness of paediatric asthma care: a qualitative evaluation of parent experiences

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Published: Sep 11, 2012
DOI: https://doi.org/10.5750/ijpcm.v2i3.252
Keywords:
Asthma child-centered care clinical communication communication consumer opinion family-centered care medical decision-making parent education parent-provider partnership patient experience psychosocial care quality improvement

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Gregory S. Sawicki
Assistant Professor of Pediatrics, Division of Respiratory Diseases, Children’s Hospital Boston, Harvard Medical School,Boston, MA, USA
Joshua Wolff
Assistant Professor, Department of Psychology, Rhode Island College, Providence, RI
Prerna S. Kahlon
Director, Quality Measurement and Improvement, Department of Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA
Elaine Chan
Research Assistant, Division of Adolescent and Young Adult Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA
Patricia Mantell
Nurse Manager, Medicine Patient Services, Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA
Sonja Ziniel
Senior Survey Methodologist, Program for Patient Safety and Quality, Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA
Elizabeth M. Klements
Asthma Clinical Nurse Specialist, Medicine Patient Services, Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA
Elizabeth R. Woods
Associate Chief, Professor of Pediatrics, Division of Adolescent and Young Adult Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA

Abstract

Rationale, aims, and objectives: The primary aim of this qualitative quality improvement project was to assess parental experiences of clinical care for their children with asthma across a continuum of healthcare settings.Method: Twenty semi-structured in-depth interviews were completed with parents of children who were hospitalized for asthma-related respiratory symptoms. Interviews were analyzed using the phenomenological method of qualitative data analysis.Results: Results revealed the presence of four major themes of importance to parents regarding their child’s asthma care: (1) importance of asthma education; (2) need for resources for asthma management; (3) provider communication and conflicting opinions; (4) determinants of satisfaction with asthma care.Conclusions: Parents of children with asthma identified areas for improvement in education, resource development and coordination of care for their children with asthma. Conflicting opinions are an identified barrier to care coordination. Coordination of asthma health services should aim to reduce conflicting opinions and improve parent-provider partnership for chronic care. Communication and caregiver education need to be incorporated into health system improvement efforts for improving outcomes for children with asthma as part of child and family-centered care.

Article Details

Issue
Vol. 2 No. 3 (2012): September
Section
Regular Articles

References

Akinbami, L.J., Moorman, J.E., Garbe, P.L. & Sondik, E.J. (2009). Status of childhood asthma in the United States, 1980-2007. Pediatrics 123 (Supplement 3) S131-145.

Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. The Journal of allergy and clinical immunology 120 (Supplement 5) S94-138.

Bender, B.G. & Rand, C. (2004). Medication non-adherence and asthma treatment cost. Current opinion in allergy and clinical immunology 4 (3) 191-195.

Rand, C.S. (2005). Non-adherence with asthma therapy: more than just forgetting. Journal of Pediatrics 146 (2) 157-159.

Lieu, T.A., Quesenberry, C.P. Jr., Capra, A.M., Sorel, M.E., Martin, K.E. & Mendoza, G.R. (1997). Outpatient management practices associated with reduced risk of pediatric asthma hospitalization and emergency department visits. Pediatrics 100 (3 Part 1) 334-341.

Toelle, B.G. & Ram, F.S. (2004). Written individualised management plans for asthma in children and adults. Cochrane database of systematic reviews (Online) 2004(2):CD002171.

Bravata, D.M., Gienger, A.L., Holty, J.E., Sundaram, V., Khazeni, N., Wise, P.H., McDonald, K.M. & Owens, D.K. (2009). Quality improvement strategies for children with asthma: a systematic review. Archives of Pediatrics & Adolescent Medicine 163 (6) 572-581.

Lozano, P., Finkelstein, J.A., Carey, V.J., Wagner, E.H., Inui, T.S., Fuhlbrigge, A.L., Soumerai, S.B., Sullivan, S.D., Weiss, S.T. & Weiss, K.B. (2004). A multisite randomized trial of the effects of physician education and organizational change in chronic-asthma care: health outcomes of the Pediatric Asthma Care Patient Outcomes Research Team II Study. Archives of Pediatrics & Adolescent Medicine 158 (9) 875-883.

Finkelstein, J.A., Lozano, P., Farber, H.J., Miroshnik, I. & Lieu, T.A. (2002). Underuse of controller medications among Medicaid-insured children with asthma. Archives of Pediatrics & Adolescent Medicine 156 (6) 562-567.

Morse, R.B., Hall, M., Fieldston, E.S., McGwire, G., Anspacher, M., Sills, M.R., Williams, K., Oyemwense, N., Mann, K.J., Simon, H.K. & Shah, S.S. (2011). Hospital-level compliance with asthma care quality measures at children's hospitals and subsequent asthma-related outcomes. Journal of the American Medical Association 306 (13) 1454-1460.

Guevara, J.P., Wolf, F.M., Grum, C.M. & Clark, N.M. (2003). Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis. British Medical Journal (Clinical research edition) 326 (7402) 1308-1309.

Moffat, M., Cleland, J., van der Molen, T. & Price, D. (2006). Sub-optimal patient and physician communication in primary care consultations: its relation to severe and difficult asthma. Primary Care Respiratory Journal 15 (3) 159-165.

Riekert, K.A., Butz, A.M., Eggleston, P.A., Huss, K., Winkelstein, M. & Rand, C.S. (2003). Caregiver-physician medication concordance and undertreatment of asthma among inner-city children. Pediatrics 111 (3) e214-220.

VanManen, M. (1990). Researching lived experiences: Human Science for an action sensitive pedagogy. Ontario, NY: State University of New York.

Williams, E.N. & Morrow, S.L. (2009). Achieving trustworthiness in qualitative research: a pan-paradigmatic perspective. Psychotherapy Research 19 (4-5) 576-582.

Cooper, P. & McIntyre, D. (1993). Commonality in teachers' and pupils' perceptions of effective classroom learning. British Journal of Educational Psychology 63, 381-399.

Loignon, C., Bedos, C., Sevigny, R. & Leduc, N. (2009). Understanding the self-care strategies of patients with asthma. Patient Education and Counseling 75 (2) 256-262.

Moffat, M., Cleland, J., van der Molen, T. & Price, D. (2007). Poor communication may impair optimal asthma care: a qualitative study. Family practice 24 (1) 65-70.

Newcomb, P.A., McGrath, K.W., Covington, J.K., Lazarus, S.C. & Janson, S.L. (2010). Barriers to patient-clinician collaboration in asthma management: the patient experience. Journal of Asthma 47 (2) 192-197.

Porter, S.C., Johnston, P., Parry, G., Damian, F., Hoppa, E.C. & Stack, A.M. (2011). Improving parent-provider communication in the pediatric emergency department: results from the clear and concise communication campaign. Pediatric Emergency Care 27 (2) 75-80.

Wolff, J., Pak, J., Meeske, K., Worden, J.W. & Katz, E. (2010). Challenges and coping styles of fathers as primary medical caretakers: a multicultural qualitative study. Journal of Psychosocial Oncology 28 (2) 202-217.

Cashin, G.H., Small, S.P. & Solberg, S.M. (2008). The lived experience of fathers who have children with asthma: a phenomenological study. Journal of Pediatric Nursing 23 (5) 372-385.

Wolf, J.M., Miller, G.E. & Chen, E. (2008). Parent psychological states predict changes in inflammatory markers in children with asthma and healthy children. Brain, Behavior and Immunity 22 (4) 433-441.

Ng, S.M., Li, A.M., Lou, V.W., Tso, I.F., Wan, P.Y. & Chan, D.F. (2008). Incorporating family therapy into asthma group intervention: a randomized waitlist-controlled trial. Family Process 47 (1) 115-130.