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Older Adults with Asthma - A Qualitative Study
S46 Abstracts
SATURDAY
164
Self-reported Medication Adherence in Patients with Nasal Allergies: the Disconnect Between Clinical Practice and Patient Behaviors S. Wagner1, A. Luskin2, D. Bukstein2, M. Kaliner2, S. Gupta1, M. Edwards3, P. Smale3; 1CHS International, Washington Crossing, PA, 2 Dean Medical Center, Madison, WI, 3Alcon Laboratories, Fort Worth, TX. RATIONALE: We investigated self reported behaviors and attitudes about adherence and compliance in patients with nasal allergies. METHODS: We analyzed self-reported data of nasal allergy patients from the 2007 National Health and Wellness Survey (NHWS). In addition, we conducted a survey (SELECT) of 655 nasal allergy patients in March 2008, from a sample of respondents. Respondents were 18 years or older, suffering from nasal allergies in the past 12 months, and treated with prescription medication. We performed bivariate analysis with INS and oral therapy as independent variables. Adherence as measured by the Morisky Adherence Scale were analyzed amongst other as the dependent variable. Statistical significance was set at the 95% confidence level. RESULTS: From the SELECT study, patients recalled being told by the physician the dosing schedule, but don’t recall the importance of taking the drug daily. Of the 63,012 respondents in the NHWS, 11,210 (17.8%) had physician diagnosed nasal allergies. Of those 5,284 were treated with a prescription drug. Only 64% respondents showed a good or complete adherence. About 38% indicated they stop taking their medications when they feel better and 39% indicated they forget to take their medication. Patients took oral medications 18 days per month, and 16 days for intranasal medications, not a statistically significant difference. CONCLUSIONS: Patients with nasal allergies use their allergy medications largely on as needed (PRN) basis, regardless of the type of medication. Given these behaviors, an important role for PRN treatment in the management of Allergic Rhinitis exists and has not been adequately addressed.
165
Physician Knowledge and Self-Perception of Proper EpiPen Administration I. Paek; Long Island College Hospital, Brooklyn, NY. RATIONALE: Self-injectable epinephrine is a potentially life-saving measure for patients with anaphylaxis. This study investigated physician knowledge of proper EpiPen administration. METHODS: Physicians practicing or training in New York City were interviewed regarding their experience with prescribing EpiPen. Participants who reported they knew how to use an EpiPen were asked to demonstrate their technique with a trainer and scored on their ability to properly administer epinephrine to themselves. RESULTS: 43 residents and 7 attending physicians participated in this study. While 70% (n 5 35) of participants reported having had a patient with anaphylaxis, only 51.4% (n 5 18) prescribed an EpiPen to these patients. Of the 48.6% (n 5 17) who didn’t prescribe an EpiPen, 7 didn’t think to prescribe, and 8 chose not to because anaphylaxis was secondary to a known agent such as drugs or radiocontrast media. 82.0% (n 5 41) of all participants felt they know when to prescribe an EpiPen, and 50% (n 5 25) have prescribed an EpiPen before. Of these physicians, only 44% (n 5 11) have instructed their patients how to use it. Of the 56% (n 5 28) of physicians reporting that they knew how to use an EpiPen, only one physician was able to perform all steps correctly. The average score was 1.39 out of a possible 4. CONCLUSIONS: Despite most physicians’ comfort with prescribing an EpiPen, it is often under-prescribed in patients with anaphylaxis. Further, although many physicians feel they know how to use an EpiPen, this study revealed most physicians are unable to demonstrate its proper usage.
J ALLERGY CLIN IMMUNOL FEBRUARY 2009
166
Long-term Effect of ``Skin Care School'' Program for Childhood Atopic Dermatitis M. Futamura1,2, K. Otsuji1, M. Hirayama1, K. Ito1, K. Hayashi3,2, Y. Ohya2, I. Masuko4,2; 1Aichi Children’s Health and Medical Center, Obu, Japan, 2National Center for Child Health and Development, Tokyo, Japan, 3Teikyo University, Tokyo, Japan, 4Gunma Prefectural College of Health Sciences, Maebashi, Japan. RATIONALE: We started parental education program for childhood atopic dermatitis, named ‘‘Skin Care School’’, in 2-days hospitalization. The purpose of this study was to examine the long-term effect of our program. METHODS: Twenty eight children (8 girls and 20 boys, aged 6 months to 5 years) with moderate to severe atopic dermatitis and their parents joined our program held every two weeks. It included lectures about atopic dermatitis, small-group discussion and 3 times of nurse assisted skincare treatment for the children to be joined by their mothers. Patients’ skin conditions including symptom scores and the amount of topical corticosteroid applied each time were evaluated by their parents before, one and six months after joining the program. RESULTS: The skin condition significantly improved at the end of the program. The skin scores (worst to best:-5 to 15) compared to that before the program improved to 13.00 in one month and 12.93 in six months. The symptom scores of pruritus and sleeplessness also significantly decreased in one month (P < 0.001, P < 0.001) and keep the decrease in six months (P 5 0.021, P 5 0.006). Furthermore, 71% and 89% parents reported the decrease in the usage of topical corticosteroids after one and six month. During the six months, the short stature of patients significantly improved from -1.07SD to -0.87SD (P 5 0.028). CONCLUSIONS: ‘‘Skin Care School’’ program was beneficial to control the childhood atopic dermatitis in terms of improvement of skin conditions and symptoms for long periods, regardless of the reduction of the usage of topical corticosteroids.
167
Older Adults with Asthma - A Qualitative Study A. P. Baptist1,2, B. K. Deol3, B. Nelson2, N. M. Clark2; 1University of Michigan, Division of Allergy, Ann Arbor, MI, 2University of Michigan, Center for Managing Chronic Disease, Ann Arbor, MI, 3Wayne State University, Detroit, MI. RATIONALE: Although many asthma patients experience their first attack after age 40, the experiences and concerns of older adults with asthma, along with the management strategies they employ, remain largely unknown. Qualitative research is one strategy that may be able to elucidate these issues. METHODS: Six focus groups were held, each consisting of participants over the age of 65 with a physician diagnosis of asthma. These focus groups were conducted either at an inner city location or at a smaller middle income city nearby. Two of the groups were held at an assisted living facility in order to get broader representation of the elderly population. Semi-structured questions regarding asthma education, symptoms, and management were used. Emergent themes and domains were defined as distinct categories and coded. RESULTS: A total of 46 adults participated in the six focus groups. The mean age of the participants was 72.6 years, and 43.5% were African American. The majority of participants had coexisting cardiac disease or hypertension. Major age-specific domains identified in all focus groups were atypical asthma symptoms, inability to distinguish asthma from other medical conditions, use of complementary and alternative therapies, desire for independence in asthma management, and a lack of participation in asthma education. Participants acknowledged that they did not commonly address these issues with their physicians or with family members. CONCLUSIONS: There are concerns, challenges, and obstacles unique to the geriatric asthmatic population. Optimal care will require physicians and researchers to explicitly address these issues.
SATURDAY
164
Self-reported Medication Adherence in Patients with Nasal Allergies: the Disconnect Between Clinical Practice and Patient Behaviors S. Wagner1, A. Luskin2, D. Bukstein2, M. Kaliner2, S. Gupta1, M. Edwards3, P. Smale3; 1CHS International, Washington Crossing, PA, 2 Dean Medical Center, Madison, WI, 3Alcon Laboratories, Fort Worth, TX. RATIONALE: We investigated self reported behaviors and attitudes about adherence and compliance in patients with nasal allergies. METHODS: We analyzed self-reported data of nasal allergy patients from the 2007 National Health and Wellness Survey (NHWS). In addition, we conducted a survey (SELECT) of 655 nasal allergy patients in March 2008, from a sample of respondents. Respondents were 18 years or older, suffering from nasal allergies in the past 12 months, and treated with prescription medication. We performed bivariate analysis with INS and oral therapy as independent variables. Adherence as measured by the Morisky Adherence Scale were analyzed amongst other as the dependent variable. Statistical significance was set at the 95% confidence level. RESULTS: From the SELECT study, patients recalled being told by the physician the dosing schedule, but don’t recall the importance of taking the drug daily. Of the 63,012 respondents in the NHWS, 11,210 (17.8%) had physician diagnosed nasal allergies. Of those 5,284 were treated with a prescription drug. Only 64% respondents showed a good or complete adherence. About 38% indicated they stop taking their medications when they feel better and 39% indicated they forget to take their medication. Patients took oral medications 18 days per month, and 16 days for intranasal medications, not a statistically significant difference. CONCLUSIONS: Patients with nasal allergies use their allergy medications largely on as needed (PRN) basis, regardless of the type of medication. Given these behaviors, an important role for PRN treatment in the management of Allergic Rhinitis exists and has not been adequately addressed.
165
Physician Knowledge and Self-Perception of Proper EpiPen Administration I. Paek; Long Island College Hospital, Brooklyn, NY. RATIONALE: Self-injectable epinephrine is a potentially life-saving measure for patients with anaphylaxis. This study investigated physician knowledge of proper EpiPen administration. METHODS: Physicians practicing or training in New York City were interviewed regarding their experience with prescribing EpiPen. Participants who reported they knew how to use an EpiPen were asked to demonstrate their technique with a trainer and scored on their ability to properly administer epinephrine to themselves. RESULTS: 43 residents and 7 attending physicians participated in this study. While 70% (n 5 35) of participants reported having had a patient with anaphylaxis, only 51.4% (n 5 18) prescribed an EpiPen to these patients. Of the 48.6% (n 5 17) who didn’t prescribe an EpiPen, 7 didn’t think to prescribe, and 8 chose not to because anaphylaxis was secondary to a known agent such as drugs or radiocontrast media. 82.0% (n 5 41) of all participants felt they know when to prescribe an EpiPen, and 50% (n 5 25) have prescribed an EpiPen before. Of these physicians, only 44% (n 5 11) have instructed their patients how to use it. Of the 56% (n 5 28) of physicians reporting that they knew how to use an EpiPen, only one physician was able to perform all steps correctly. The average score was 1.39 out of a possible 4. CONCLUSIONS: Despite most physicians’ comfort with prescribing an EpiPen, it is often under-prescribed in patients with anaphylaxis. Further, although many physicians feel they know how to use an EpiPen, this study revealed most physicians are unable to demonstrate its proper usage.
J ALLERGY CLIN IMMUNOL FEBRUARY 2009
166
Long-term Effect of ``Skin Care School'' Program for Childhood Atopic Dermatitis M. Futamura1,2, K. Otsuji1, M. Hirayama1, K. Ito1, K. Hayashi3,2, Y. Ohya2, I. Masuko4,2; 1Aichi Children’s Health and Medical Center, Obu, Japan, 2National Center for Child Health and Development, Tokyo, Japan, 3Teikyo University, Tokyo, Japan, 4Gunma Prefectural College of Health Sciences, Maebashi, Japan. RATIONALE: We started parental education program for childhood atopic dermatitis, named ‘‘Skin Care School’’, in 2-days hospitalization. The purpose of this study was to examine the long-term effect of our program. METHODS: Twenty eight children (8 girls and 20 boys, aged 6 months to 5 years) with moderate to severe atopic dermatitis and their parents joined our program held every two weeks. It included lectures about atopic dermatitis, small-group discussion and 3 times of nurse assisted skincare treatment for the children to be joined by their mothers. Patients’ skin conditions including symptom scores and the amount of topical corticosteroid applied each time were evaluated by their parents before, one and six months after joining the program. RESULTS: The skin condition significantly improved at the end of the program. The skin scores (worst to best:-5 to 15) compared to that before the program improved to 13.00 in one month and 12.93 in six months. The symptom scores of pruritus and sleeplessness also significantly decreased in one month (P < 0.001, P < 0.001) and keep the decrease in six months (P 5 0.021, P 5 0.006). Furthermore, 71% and 89% parents reported the decrease in the usage of topical corticosteroids after one and six month. During the six months, the short stature of patients significantly improved from -1.07SD to -0.87SD (P 5 0.028). CONCLUSIONS: ‘‘Skin Care School’’ program was beneficial to control the childhood atopic dermatitis in terms of improvement of skin conditions and symptoms for long periods, regardless of the reduction of the usage of topical corticosteroids.
167
Older Adults with Asthma - A Qualitative Study A. P. Baptist1,2, B. K. Deol3, B. Nelson2, N. M. Clark2; 1University of Michigan, Division of Allergy, Ann Arbor, MI, 2University of Michigan, Center for Managing Chronic Disease, Ann Arbor, MI, 3Wayne State University, Detroit, MI. RATIONALE: Although many asthma patients experience their first attack after age 40, the experiences and concerns of older adults with asthma, along with the management strategies they employ, remain largely unknown. Qualitative research is one strategy that may be able to elucidate these issues. METHODS: Six focus groups were held, each consisting of participants over the age of 65 with a physician diagnosis of asthma. These focus groups were conducted either at an inner city location or at a smaller middle income city nearby. Two of the groups were held at an assisted living facility in order to get broader representation of the elderly population. Semi-structured questions regarding asthma education, symptoms, and management were used. Emergent themes and domains were defined as distinct categories and coded. RESULTS: A total of 46 adults participated in the six focus groups. The mean age of the participants was 72.6 years, and 43.5% were African American. The majority of participants had coexisting cardiac disease or hypertension. Major age-specific domains identified in all focus groups were atypical asthma symptoms, inability to distinguish asthma from other medical conditions, use of complementary and alternative therapies, desire for independence in asthma management, and a lack of participation in asthma education. Participants acknowledged that they did not commonly address these issues with their physicians or with family members. CONCLUSIONS: There are concerns, challenges, and obstacles unique to the geriatric asthmatic population. Optimal care will require physicians and researchers to explicitly address these issues.