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Improving youth question-asking and provider education during pediatric asthma visits.

ABSTRACT: OBJECTIVE:We conducted a pragmatic randomized controlled trial to test the effectiveness of an asthma question prompt list with video intervention to increase youth question-asking and provider education during visits. METHODS:English or Spanish-speaking youth ages 11-17 with persistent asthma and their parents were enrolled from four rural and suburban pediatric clinics. Youth were randomized to the intervention or usual care groups. Intervention group adolescents watched the video on an iPad and then completed an asthma question prompt list before their visits. Generalized estimating equations were used to analyze the data. RESULTS:Forty providers and 359 patients participated. Intervention group youth were significantly more likely to ask one or more questions about medications, triggers, and environmental control than usual care youth. Providers were significantly more likely to educate intervention group youth about rescue medications, triggers, and environmental control. Intervention group caregivers were not significantly more likely to ask questions. CONCLUSION:The intervention increased youth question-asking and provider education about medications, triggers, and environmental control. The intervention did not impact caregiver question-asking. PRACTICE IMPLICATIONS:Providers/practices should consider having youth complete question prompt lists and watch the video with their parents before visits to increase youth question-asking during visits.

SUBMITTER: Sleath B

PROVIDER: S-EPMC5963523 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Improving youth question-asking and provider education during pediatric asthma visits.

Sleath Betsy B Carpenter Delesha M DM Davis Scott A SA Watson Claire Hayes CH Lee Charles C Loughlin Ceila E CE Garcia Nacire N Reuland Daniel S DS Tudor Gail G

Patient education and counseling 20180131 6

<h4>Objective</h4>We conducted a pragmatic randomized controlled trial to test the effectiveness of an asthma question prompt list with video intervention to increase youth question-asking and provider education during visits.<h4>Methods</h4>English or Spanish-speaking youth ages 11-17 with persistent asthma and their parents were enrolled from four rural and suburban pediatric clinics. Youth were randomized to the intervention or usual care groups. Intervention group adolescents watched the vid ...[more]

PMID: 29402570

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Project description:BackgroundEfforts to reduce opioid overdose fatalities have resulted in tapering (i.e., reducing or discontinuing) opioid prescriptions despite a limited understanding of patients' experiences.ObjectiveTo explore patients' perspectives on opioid taper experiences to ultimately improve taper processes and outcomes.DesignQualitative study.ParticipantsPatients on long-term opioid therapy for chronic pain who had undergone a reduction of opioid daily prescribed dosage of ≥50% in the past 2 years in two distinct medical systems and regions.ApproachFrom 2019 to 2020, we conducted semi-structured interviews that were audio-recorded, transcribed, systematically coded, and analyzed to summarize the content and identify key themes regarding taper experiences overall and with particular attention to patient-provider relationships and provider communication during tapers.Key resultsParticipants (n=41) had lived with chronic pain for an average of 17.4 years (range, 3-36 years) and described generally adverse experiences with opioid tapers, the initiation of which was not always adequately justified or explained to them. Consequences of tapers ranged from minor to substantial and included withdrawal, mobility issues, emotional distress, exacerbated mental health symptoms, and feelings of social stigmatization for which adequate supports were typically unavailable. Narratives highlighted the consequential role of patient-provider relationships throughout taper experiences, with most participants describing significant interpersonal challenges including poor provider communication and limited patient engagement in decision making. A few participants identified qualities of providers, relationships, and communication that fostered more positive taper experiences and outcomes.ConclusionsFrom patients' perspectives, opioid tapers can produce significant physical, emotional, and social consequences, sometimes reducing trust and engagement in healthcare. Patient-provider relationships and communication influence patients' perceptions of the quality and outcomes of opioid tapers. To improve patients' experiences of opioid tapers, tapering plans should be based on individualized risk-benefit assessments and involve patient-centered approaches and improved provider communication.

Project description:Many air pollutants and climate variables have proven to be significantly associated with pediatric asthma and have worsened asthma symptoms. However, their exact causal effects remain unclear. We explored the causality between air pollutants, climate, and daily pediatric asthma patient visits with a short-term lag effect. Based on eight years of daily environmental data and daily pediatric asthma patient visits, Spearman correlation analysis was used to select the air pollutants and climate variables that correlated with daily pediatric asthma patient visits at any time (with a lag of 1-6 days). We regarded these environmental variables as treatments and built multiple- and single-treatment causal inference models using the Dowhy library (a Python library for causal inference by graphing the model, quantitatively evaluating causal effects, and validating the causal assumptions) to estimate the quantitative causal effect between these correlated variables and daily pediatric asthma patient visits in lag time. The multiple-treatment causal inference model was a model with 8 treatments (Visibility, Precipitation, PM10, PM2.5, SO2, NO2, AQI and CO), 1 outcome (daily pediatric asthma patients visits), and 5 confounders (Humidity, Temperature, Sea level pressure, wind speed and unobserved confounders "U"). Single-treatment causal inference models were 8 models, and each model has 1 treatment, 1 outcome and 12 confounders. Spearman correlation analysis showed that precipitation, wind speed, visibility, air quality index, PM2.5, PM10, SO2, NO2, and CO were significantly associated variables at all times (p < 0.05). The multiple-treatment model showed that pooled treatments had significant causality for the short-term lag (lag1-lag6; p < 0.05). Causality was mainly due to SO2. In the single-treatment models, visibility, SO2, NO2, and CO exhibited significant causal effects at any one time (p < 0.05). SO2 and CO exhibited stronger positive causal effects. The causal effect of SO2 reached its maxima (causal effect = 11.41, p < 0.05) at lag5. The greatest causal effect of CO appeared at lag3 (causal effect = 10.67, p < 0.05). During the eight year-period, the improvements in SO2, CO, and NO2 in Hangzhou were estimated to reduce asthma visits by 8478.03, 3131.08, and 1341.39 per year, respectively. SO2, NO2, CO, and visibility exhibited causal effects on daily pediatric asthma patient visits; SO2 was the most crucial causative variable with a relatively higher causal effect, followed by CO. Improvements in atmospheric quality in the Hangzhou area have effectively reduced the incidence of asthma.

Project description:IntroductionQuestion prompt lists (QPLs) have been found to support patients to ask questions and improve the information they receive from doctors. However, some QPL tools, which have been available online for almost 15 years, have little published data on their impact in real-world settings. This study's aim was to understand patients' attitudes and experiences accessing health information and to assess the impact of introducing two generic QPLs over 3 months.MethodsA longitudinal qualitative study consisting of three semi-structured interviews over a three-month period was conducted with 31 purposively selected participants, adults ≥18 years, recruited online and through social media. Participants were introduced to two different QPLs currently available online ('Question Builder'; 'AskShareKnow'). Inductive thematic analysis of a total of 92 semi-structured telephone interviews was conducted during May-November 2020.ResultsThree main themes are described. (1) Participants described barriers and facilitators to accessing health information: navigating a complex health system; difficulty asking questions of their healthcare professionals and that they value doctors with good communication skills. (2) QPLs helped some participants recognize the role of question-asking in consultations, made them feel more empowered and helped them prepare and prioritize. (3) Participants wanted QPLs to be easier to use, be accessible when needed and that question-asking and QPLs should be normalized in medical consultations.ConclusionsWell-designed and easily accessible QPLs can empower people to ask questions and be more involved in decisions about their health care. Endorsement of question-asking in consultations by healthcare professionals and providing QPL tools at the point of contact with health services will be key to realizing the potential of QPLs.Patient or public contributionThis study was completed in conjunction with a reference group consisting of a consumer representative, representatives from the Australian Commission on Safety and Quality in Health Care, Healthdirect Australia Ltd., and the research team.

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Improving youth question-asking and provider education during pediatric asthma visits.

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Improving youth question-asking and provider education during pediatric asthma visits.

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