Does the care of inner-city asthmatic children by pediatric residents follow the asthma guidelines?

V. N. Gan, P. Hicks, K. Kalayanamit, J. Naish

Research output: Contribution to journalArticle

Abstract

Objective. To assess pediatric house staff on outpatient management of inner-city asthmatic children. Design/methods. Retrospective chart review. Setting. Hospital-based residents' continuity clinic. Main outcome measures. A comparison with the asthma management guidelines issued by the National Heart Lung Blood institute (NHLBI). Results. For the 100 patients reviewed, 83 were between 5 and 12 years of age. Eighty percent of children were African-American or Hispanic and 28% had no health insurance. Sixty-five percent had at least one previous hospitalization for asthma. The history of triggers was noted in 74% of cases. Exercise was cited as a trigger in 33%. Only 16% and 5% of cases considered exposure to smoking and a pet, respectively, as a trigger. The functional status of patients was addressed in 16%. Patients in moderate or severe categories accounted for 87% of the studied group. Anti-inflammatory agents were prescribed in 67% of cases in moderate and severe asthmatic children. Conclusions. The study shows that the use of anti-inflammatory agents in moderate and severe asthmatic children is lower that those recommended by the NHLBI guidelines. We found our house staff's documentation to be incomplete in addressing the functional status of asthmatic children. Therefore, the needs of these patients were not properly assessed, including the use of a spacer device and preventative strategies using such monitoring. Implications for practice. Residents in training learn and practice their approach to patient care in a protected and somewhat idealistic environment. They are closely monitored and are given ample education information. Teaching of guidelines and demonstrating such knowledge is the first step. Assessing implementation of such guidelines is of equal importance because it is the actual practice of this knowledge which will impact on patients. It is important that all practices, within and beyond residency assess the implementation of proven therapeutic approaches to patient care.

Original languageEnglish (US)
Pages (from-to)173-179
Number of pages7
JournalAmbulatory Child Health
Volume4
Issue number2
StatePublished - Jan 1 1998

Keywords

  • Ambulatory care
  • Asthma
  • Children
  • Pediatric residents

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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