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.

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 SEARCH STRATEGY The search strategy examined both published and unpublished studies from 1970 to present that were written in the English language.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.