A systematic review of the effectiveness of patient-centred care on emergency room visits, hospitalizations, unscheduled sick clinic visits, and missed school days for children with asthma.

C. Barnes, Eugene Cauvin, Meral Duran-Kim, Lisa A Montalbano, M. Londrigan
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OBJECTIVES The objective of this systematic review was to identify, appraise, and synthesize the best available evidence to determine the effectiveness of patient-centred care on emergency room visits, hospitalizations, unscheduled primary care provider visits, and missed school days in the management of children with asthma. INCLUSION CRITERIA The review considered studies that included children from newborn to seventeen years of age with a clinical diagnosis of asthma who were being treated in an outpatient healthcare setting, regardless of severity, previous treatments, co-morbidities, and ethnic or socioeconomic backgrounds.The review considered studies that evaluated the effects of the patient-centred care model in the management of children with asthma.This review considered studies that included the following outcome measures: emergency room (ER) visit rates, hospital admission rates, unscheduled primary care provider visit rates, and number of missed school days per year associated with asthma symptoms.The review considered any randomized controlled trials (RCTs) and quasi-experimental clinical controlled trials (CCTs). SEARCH STRATEGY The search strategy examined both published and unpublished studies from 1970 to present that were written in the English language. The databases searched included: Medline, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Academic Search Premier, PsycINFO, Healthsource Nursing/Academic edition, and PubMed. A grey literature search was performed. METHODOLOGICAL QUALITY Papers that met the inclusion criteria were assessed by two independent reviewers for methodological validity prior to inclusion in the review, using the standardized critical appraisal instrument from Joanna Briggs Institute. DATA EXTRACTION Data was extracted using the standardized data extraction tool from the JBI - MAStARI. DATA SYNTHESIS Statistical pooling was not possible due to heterogeneity of the studies; therefore the findings were presented in a narrative form. RESULTS Ten studies (nine RCTs and one quasi-experimental CCT) were included in the review. Nine of the studies looked at the outcome of hospitalizations of which five showed a decline in hospitalizations when a patient-centred care model was used; two were significant with p values of <0.05 and <0.001. Eight studies looked at the outcome of ER visits. Six of these reported a decline in ER visits after the intervention of which three were significant with p values of <0.001, <0.05 and <0.05. Six studies looked at missed school days of which one showed a significant difference after the intervention (p< 0.01), while four reported a decline in missed school days but did not report significance. Four studies look at unscheduled primary care provider visits of which one reported a significant difference after the intervention (p < 0.05). CONCLUSIONS The findings of this review suggest that positive outcomes specific to emergency room visits, hospitalizations, unscheduled primary care provider visits and missed school days are engendered in children with asthma when care is patient-centred, asthma care plans are individualized and when an educational component is incorporated.This review supports paediatric asthma care that is patient-centred and focuses on mutual partnership, education, and clinical support.This review underscores the need for continued research in order to determine the most effective modality, nature, and duration of patient-centred interventions to be used with asthmatic children in order to improve patient outcomes.","PeriodicalId":91723,"journal":{"name":"JBI library of systematic reviews","volume":"10 14 1","pages":"832-894"},"PeriodicalIF":0.0000,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JBI library of systematic reviews","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.11124/01938924-201109481-00017","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 2

Abstract

BACKGROUND Childhood asthma is a major clinical concern worldwide, associated with increased levels of morbidity and missed school days, placing a heavy strain on healthcare systems in terms of both financial cost and hospital usage. The utilization of suitable therapy, written treatment plans, and patient education have been the focus of many interventional strategies to improve outcomes. OBJECTIVES The objective of this systematic review was to identify, appraise, and synthesize the best available evidence to determine the effectiveness of patient-centred care on emergency room visits, hospitalizations, unscheduled primary care provider visits, and missed school days in the management of children with asthma. INCLUSION CRITERIA The review considered studies that included children from newborn to seventeen years of age with a clinical diagnosis of asthma who were being treated in an outpatient healthcare setting, regardless of severity, previous treatments, co-morbidities, and ethnic or socioeconomic backgrounds.The review considered studies that evaluated the effects of the patient-centred care model in the management of children with asthma.This review considered studies that included the following outcome measures: emergency room (ER) visit rates, hospital admission rates, unscheduled primary care provider visit rates, and number of missed school days per year associated with asthma symptoms.The review considered any randomized controlled trials (RCTs) and quasi-experimental clinical controlled trials (CCTs). SEARCH STRATEGY The search strategy examined both published and unpublished studies from 1970 to present that were written in the English language. The databases searched included: Medline, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Academic Search Premier, PsycINFO, Healthsource Nursing/Academic edition, and PubMed. A grey literature search was performed. METHODOLOGICAL QUALITY Papers that met the inclusion criteria were assessed by two independent reviewers for methodological validity prior to inclusion in the review, using the standardized critical appraisal instrument from Joanna Briggs Institute. DATA EXTRACTION Data was extracted using the standardized data extraction tool from the JBI - MAStARI. DATA SYNTHESIS Statistical pooling was not possible due to heterogeneity of the studies; therefore the findings were presented in a narrative form. RESULTS Ten studies (nine RCTs and one quasi-experimental CCT) were included in the review. Nine of the studies looked at the outcome of hospitalizations of which five showed a decline in hospitalizations when a patient-centred care model was used; two were significant with p values of <0.05 and <0.001. Eight studies looked at the outcome of ER visits. Six of these reported a decline in ER visits after the intervention of which three were significant with p values of <0.001, <0.05 and <0.05. Six studies looked at missed school days of which one showed a significant difference after the intervention (p< 0.01), while four reported a decline in missed school days but did not report significance. Four studies look at unscheduled primary care provider visits of which one reported a significant difference after the intervention (p < 0.05). CONCLUSIONS The findings of this review suggest that positive outcomes specific to emergency room visits, hospitalizations, unscheduled primary care provider visits and missed school days are engendered in children with asthma when care is patient-centred, asthma care plans are individualized and when an educational component is incorporated.This review supports paediatric asthma care that is patient-centred and focuses on mutual partnership, education, and clinical support.This review underscores the need for continued research in order to determine the most effective modality, nature, and duration of patient-centred interventions to be used with asthmatic children in order to improve patient outcomes.
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对以患者为中心的护理在急诊室就诊、住院、计划外门诊就诊和哮喘儿童缺课日等方面的有效性进行系统回顾。
儿童哮喘是世界范围内的一个主要临床问题,与发病率增加和缺课有关,在财务成本和医院使用方面给卫生保健系统带来了沉重的压力。使用合适的治疗方法、书面治疗计划和患者教育一直是许多干预策略的重点,以改善结果。本系统综述的目的是识别、评价和综合现有的最佳证据,以确定以患者为中心的护理在哮喘儿童的急诊室就诊、住院、未安排的初级保健提供者就诊和缺课日管理中的有效性。纳入标准:本综述纳入了从新生儿到17岁临床诊断为哮喘且在门诊医疗机构接受治疗的儿童,无论其严重程度、既往治疗、合并症、种族或社会经济背景如何。该综述考虑了评估以患者为中心的护理模式在哮喘儿童管理中的效果的研究。本综述考虑了包括以下结局指标的研究:急诊室(ER)就诊率、住院率、未安排的初级保健提供者就诊率以及每年与哮喘症状相关的缺课天数。本综述纳入了所有随机对照试验(rct)和准实验临床对照试验(cct)。检索策略检索策略检查了从1970年至今用英语撰写的已发表和未发表的研究。检索的数据库包括:Medline、CINAHL、Cochrane中央对照试验注册库(Central)、EMBASE、Academic Search Premier、PsycINFO、Healthsource Nursing/Academic edition和PubMed。进行灰色文献检索。方法学质量符合纳入标准的论文在纳入之前由两名独立的审稿人评估方法学有效性,使用乔安娜布里格斯研究所的标准化关键评估工具。数据提取使用标准化数据提取工具从JBI - MAStARI中提取数据。由于研究的异质性,无法进行统计汇总;因此,调查结果以叙述形式提出。结果共纳入10项研究(9项rct和1项准实验CCT)。其中九项研究考察了住院治疗的结果,其中五项研究表明,当采用以患者为中心的护理模式时,住院率有所下降;其中2例显著性差异,p值分别<0.05和<0.001。八项研究着眼于急诊室就诊的结果。其中6个报告干预后急诊就诊次数下降,其中3个显著,p值分别为<0.001、<0.05和<0.05。六项研究考察了缺课天数,其中一项研究在干预后显示了显著差异(p< 0.01),而四项研究报告了缺课天数的减少,但没有报告显著性。四项研究调查了未安排的初级保健提供者就诊情况,其中一项研究报告干预后有显著差异(p < 0.05)。结论:本综述的研究结果表明,当护理以患者为中心、哮喘护理计划个体化并纳入教育成分时,哮喘儿童的急诊就诊、住院、未安排的初级保健提供者就诊和缺课日均可产生积极的结果。本综述支持以患者为中心的儿科哮喘护理,注重相互合作、教育和临床支持。本综述强调需要继续研究,以确定以患者为中心的干预措施的最有效方式、性质和持续时间,以改善哮喘儿童的预后。
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