Barriers to Asthma Management

Barriers to Asthma Management Renate Jimerson, Pat LeBlanc, Centrella Stacks Asthma Asthma, the most common chronic illness of childhood, is an inflammatory disease characterized by hyper responsiveness of the airways to stimuli and reversible airway obstruction (Janson, 1998). According to the American Lung Association (ALA) it affects between 6.7 and 9.6 million U.S. children under the age of 18, American Lung Association (ALA) (as cited in Toole 2013). Asthma is the most common chronic childhood disease with increasing prevalence from 31.4 per 1000 population in 1980 to 54.6 per 1000 population in 2000 despite the advances in asthma pathophysiology understanding and treatment (Tsakiris, Iordanidou, Paraskakis, Talskidis, Rigas, Zimeras, Katsardis, Chatzimichael, 2013). Although there have been new medications and medical advances, asthma is a significant cause of a morbidity, school absenteeism, parent lost work days, emergency department (ED) visits, and hospitalizations for children all over the world. Brown, Gallagher, Fowler, Wales; Martinez; Mattke, Martorell, Sharma, Malveaux, Lurie (as cited in Toole 2013). Looking into the causes of school absenteeism, it has been found that asthma is the most frequent cause, according to Doull et al., â€Å"55% of school students and 55% of asthmatic students missed school days due to respiratory symptoms.† Attendance and the limitation of daily activities are both used as indicators of asthma control level in children. Increased absenteeism interrupts learning processes and participation in daily activities. Unfortunately â€Å"In a study that specifically focused on parents’ report of receiving written self-management tools from pediatric primary care physicians, Cabana et al. (8) found that only about 30% of parents reported receiving these tools known to facilitate children’s medical adherence.† (Orrell-Valente, Jones, Manasse, Thyne, Shenkin, Cabana (2011). An initial literature review was done to gain information about what barriers impact medication compliance with school age children. Using different keywords: children, medication compliance, asthma, cost, education, barriers and impact of non ­compliance; were used in the CINAHL database, Google Search, and the Simmons Library to locate information on the subject. Further searches were conducted to refine the topic, from medication compliance with school age children to a more specific topic of medication compliance and asthmatic children. Identifying asthma as the main subject allowed for us to move in a more specific direction. Our next pursuit was in identifying and categorizing the different barriers, determining the major and minor subjects and listing them under specific categories. â€Å"No one risk factor is responsible for asthma morbidity; rather a plethora of factors contribute to the high prevalence, which vary dramatically among children with asthma (Clark, Mitchell, Rand, 2009). Asthma risk factors include living in poverty in the inner-city, being uninsured or Medicaid enrolled, and being African American or Hispanic (Akinbami, Moorman, Garbe, Sondik, 2009; Bloomber et al., 2009; Gerald et al.; Liu Pearlman, 2009; Mattke et al., 2009; Smith, 2009) (Toole, 2013 p 115).† â€Å"In 2005, 9% of children under the age of 14 years were diagnosed with asthma and the prevalence of asthma was found to be highest in this age group (Center for Disease Control and Prevention, Control and Prevention, 2006).† (Kamps, J. L., Rapoff, M. A., Roberts, M. C., Varela, R. E. Barnard, M., Olson, N., 2008 p. 206). Critiquing the research articles that were found has led to three major barriers in asthma management. The first barrier is in cost. Subcategories of cost include insurance availability, income, and socio economic levels. The second is culture. Subcategories of culture include language barriers, legal status, traditions and use of alternative medicine. The last is education. Subcategories of education include health literacy, education level, reading and comprehension abilities, information provided and follow up. Barriers that impact and interfere with the management of asthma in children are varied. The outcome of ineffective management are increase cost, hospitalizations, improper use of medication and death. Health care providers need to ensure that the patient and parent or guardian understand the proper use of medication, the disease process and associated risk for misuse of medication. Using these categories, a literature review will be a guide in determining the best practice for improving outcomes, decreasing cost, and developing a plan to ensure cooperation between parents, children and the health care provider. Asthma management requires a multi-faceted approach, including an effective educational component (Ambulatory Pediatrics, 2006). Poor patient outcomes have been associated with a lack of patient and parent compliance with the patient’s individualized treatment plan. There are a number of possible factors that may play a role in patients’ and parents’ noncompliance. They include financial and cultural barriers, and parents’ and patients’ misconception about the disease process and the importance of treatment (Cleveland, 2013). The trends reported in a recent study indicated that asthma education to parents positively impacts asthma-related outcomes in children (Kielb, Lin, Hwang, 2007). In this small sample, there was a decrease in asthma-related sick visits post-education. Asthma cost are increasing and responsible for a higher percentage of the total health care cost for treatment. Increasing and changing copayment are leading to more emergency room visits and hospitalizations. The cost of these are not as visible as the direct cost of an inhaler medications. So the need for educating on all the cost of asthma are important. In the article â€Å"Outpatient Management of Asthma in Children† by Andre Schultz and Andrew C. Martin, they discuss the roles of the provider in the diagnosis and treatment of asthma in children. This article determined that one of the critical areas is non adherence to treatment. Having a plan in place is important as well as continued follow up, avoidance of triggers, and use of medication. Non adherence to medication is impacted by the several factors. Socioeconomic status plays a large role in adherence to medication. Data obtained shows that lower adherence is reported in children at a higher rate from low income families. Perception of cost and the discussion between the Practitioner and patients is important. Determining how the client feels about the medication, treatment plan and chronic disease is important. This will help to facilitate the response to care. The perception of the cost of medication on the client will play a significant role. Not discussing these important facts with the clients may lead to non-compliance. (Patel, M. R., Coffman, J. M., Tseng, Chien-Wen, Clark, N. M. and Cabana, M. D.). In a quasi-experimental study done in 2010, they compared participants in a control and intervention group in regards to adherence to medication, healthcare cost and resource utilization. The determined intervention consisted of 2 components. One an average reduction in copayment and the second was mailing educational material for asthma management. Adherence was determine by the medication available during the duration of therapy and total supply of medication divided by the duration of therapy. When refills overlapped, it was assumed that the client consumed all medications. Healthcare resource was determined by office visits, hospitalizations, emergency room visit, short acting beta-agonist canisters and oral corticosteroid prescriptions. Cost were defined as total amount paid for visits, hospitalizations, emergency room visits, and prescription drugs. Overall cost were determined during the twelve month follow up period. Monthly cost were used rather than total cost during the st udy period. This study showed improved adherence to controller medication which translated into reduced medical cost and increased prescription cost. Although there were an increase in prescription cost the overall expenditure decreased. This study determined that increasing copayments will create a financial barrier to medication adherence. (DSouza, A., Rahnama, R., Regan, T., Common, B., Burch, S. (2010). Understanding that noncompliance to medication comes from the perspective of the client. In children, parents are the main administers of medication. A link between the socioeconomics, cultural values, education and use of medication has been shown to produce a negative effect on adherence. This effect is not a single factor but many factors grouped together to provide a complete picture. Clearly identifying the factors that influence compliance with clients will ensure a more effective management in children with asthma. References Bloomberg, G. R., Banister, C., Sterkel, R., Epstein, J., Bruns, J., Swerczek, L., et al. (2009). Socioeconomic, family, and pediatric practice factors that affect level of asthma control. Pediatrics, 123(3), 829-835. Brooten, D., Youngblut, J. M., Royal, S., Cohn, S., Lobar, S. L., Hernandez, L. (2008). Outcomes of an asthma program: Healthy children, healthy homes. Pediatric Nursing, 34(6), 448-455. Clayton, S. (2014). Adherence to asthma medication. Nurse Prescribing, 12(2), 68-74. Cleveland, K.K. (2013). Evidence-based Asthma Education for Parents. Journal for Specialists in Pediatric Nursing, 18(1), 25-32. doi: 10.111/jspn.12007 Cloutier, M., Jones, G., Hinckson, V., Wakefield, D. (2008). Effectiveness of an Asthma Management Program in Reducing Disparities of Care in Urban Children. Annals of Allergy, Asthma, and Immunology, 100(6), 545-550. doi: 1.1016/S1081-1206(10) 60058-0. Communication and Education about Asthma in Rural and Urban Schools (2006). Ambulatory Pediatrics, 6(4), 198-203. DSouza, A., Rahnama, R., Regan, T., Common, B., Burch, S. (2010). The h-e-b value-based health management program: impact on asthma medication adherence and healthcare cost. American Health Drug Benefits, 3(6), 394-401. Hoover, E., L., Pierce, C., S., Spencer, G., A., Britten, M., X., Neff-Smith, M., James, G., D., et al. (2012). Relationships among functional health literacy, asthma knowledge and the ability to care for asthmatic children in rural dwelling parents. Online Journal of Rural Nursing Health Care, 12(2), 30-40. Kamps, J. L., Rapoff, M. A., Roberts, M. C., Varela, R. E. Barnard, M., Olson, N. (2008) Improving adherence to inhaled corticosteroids in children with asthma: a  pilot of randomized clinical trial. Children’s Health Care (CHILD HEALTH CARE), 2008. Oct ­Dec; 37 (4): 261 ­77. Kielb, C., Len, S. Hwang, S. (2007). Asthma Prevalence, Management, and Education in New York State Elementary Schools; A Survey of School Nurses. Journal of School Nursing, 23(5), 267-275. Orrel-Valente, J., Jones, K., Manasse, S., Thyne, S. M., Shenkin, B. N., Cabana, M. D. (2011). Childrens and parents report of asthma education received from physicians. Journal of Asthma, 48(8), 831-838. Patel, M., Brown, R., Clark, N. (2013). Perceived parent financial burden and  asthma outcomes in low-income, urban children. Journal Of Urban Health,  90(2), 329-342. doi:10.1007/s11524-012-9774-7. Patel, M. R., Coffman, J. M., Tseng, Chien-Wen, Clark, N. M. and Cabana, M. D. Physician Communication Regarding Cost When Prescribing Asthma Medication to Children CLIN PEDIATR June 2009 48: 493-498, first published on January 21, 2009 doi:10.1177/0009922808330110. Schultz, A., Martin, A. C. (2013). Outpatient Management of Asthma in Children.  Clinical Medicine Insights: Pediatrics, (7), 13-24. doi:10.4137/CMPed.S7867 Toole, K., P. (2013). Helping children gain asthma control: Bundled school-based  interventions. Pediatric Nursing, 39(3), 115-124. Tsakiris, A., Iordanidou, M., Paraskakis, E., Tsalkidis, A., Rigas, A., Zimeras, S., Katsardis, C. Chatzimichael, A. (2013). The presence of asthma, the use of inhaled steroids, andparental education level affect school performance in children. BioMed ResearchInternational, vol. 2013

Impact of a major change at Blacks Essay

As I also stated in my introduction there have been many changes at Blacks recently in the last few months. Blacks are a fairly new business but have already become on of the UK’s leading suppliers of outdoor gear. Since opening they have generated high revenue and have been highly profitable every year. Every year Blacks beats the previous year in sales which shows that their market share is also increasing. As Blacks looked at their financial status at the beginning of the year and looked at their objectives there was suddenly an opportunity in the market. Competitor called Outdoors, who supply similar products to Blacks for camping was in financial crisis. The only way for Blacks to increase their market share is to close in on competitors. Blacks saw their opportunity and starting buying Outdoors’ shares. Before buying shares though Blacks approached Outdoors and asked if they would be willing to comply with a friendly take over, but they rejected hoping that there financial crisis would be resolved. It soon became obvious that they were in too much debt so Blacks seized their opportunity and bought them out. A hostile takeover was imposed and there was nothing the firm could do. They tried to resist the takeover bid but could not manage the finances. The board of directors did their best to ensure shareholders that their interests would be best protected with the current board but many fled They are now in the process of changing these stores into Blacks stores. The implication of this change has had a big effect on both Blacks’ employees and Outdoors’ employees. There were feelings of fear as to what will happen with so many job that and who would work in the new stores. In order to show compassion to the existing workers of Outdoors it was decided that they were going to keep the majority of workers and only make a few redundant that had little product knowledge or were just simply not needed. However the staffs were assured that changes would be made in the culture so as to meet the required level of customer service that Blacks offer. This caused some unrest as they resisted to changes Due to workers being let go some rumours got around through to Blacks stores that existing Blacks employees may have been dropped. However it was just a rumour that fizzled out and started with no real reliable source. This was one main change that happened at Blacks. Another was the change of manager at the beginning of the year. As I have already stated the change in manager has not been the best to date. The new manger has adopted an autocratic style of management. This leaves no space for ideas to be shared or any participation in decision making. As a result of this many workers were threatening to leave as before the manger had come we were constantly making bonus by reaching our targets. Since he came though, we have not been able to make target because the workers are de-motivated. Ways of handling Resistance to Change The new changes at Blacks have affected the natural order of things at the workplace, for example, new working practices will be introduced, staff have been made redundant and some staff may be re-located to new stores. This in itself will lead a natural resistance to change, so the question is: how should managers handle this resistance to change? I will propose six easy steps: 1. Managers should keep workers informed at each stage as to what is going to happen. This can be done by having: -regular staff meetings -regular discussions -issue bulletins -team briefings 2. Managers need to involve workers in the decision making process. This way it helps them to feel a part of the organisation 3. Take steps to avoid rumours spreading and misinformation circulating within and outside the company 4. Set up works council where worker representatives can meet with senior management and discuss issues pertaining to the future of the business 5. Invest in training to enable workers to cope with change, also offer counselling to the workers who may need to be made redundant 6. Review the organisational culture to ensure it fits with the future plans for the business

The Argument About Free Descriptive Essay Samples and Examples

The Argument About Free Descriptive Essay Samples and Examples Essay writing comes in various forms. Writing an essay has to be stressful. It is a gift that comes naturally. Before writing a descriptive essay, you ought to be able to understand how you are likely to encrypt your essay to meet up with the question requirements. The title for your essay is dependent upon the topic is provided. Ahead of writing, you've got to understand the subject of your essay! Picking an excellent topic for your essay is critical. Possessing good essay examples provides the reader an in-depth and on-the-court idea about what a well structured and coherent essay appears like. When you must consider many peculiarities, it's really hard to consider all of them while writing especially once you have tight deadlines and much work to do. The main issue to be mindful about in personal descriptive essay is that there shouldn't be any over-exaggeration. If you would like to create a descriptive essay about your own personal experience, it might be unusual and specific. Life, Death and Free Descriptive Essay Samples and Examples If you are searching for descriptive essay examples here's a great one below. An essay outline sample provides ideas about how to make your own outline and is very useful if it's in precisely the same subject as your assignment. On the 1 hand, our descriptive essay outline sample will offer you a sense of the essential sections and portions of a descriptive essay. Discover how to compose an excellent descriptive paragraph with these examples and suggestions. If you are in need of a trustworthy source with academic samples, you're at the proper place! A distinctive gearbox is necessary for the Chiron because all available units find it impossible to manage the engine specification. To stick to the subject, you must incorporate a description of this issue and why it can be relevant or interesting to the reader. A helpful collection of descriptive essay suggestions and topics are available here. You need to be prepared to deal with any topic whenever you have the essay format. On our page you may find a lot of examples of descriptive writing and several other essays on several topics. The Secret to Free Descriptive Essay Samples and Examples The excess detail really helps us visualize the scene that the author is attempting to create. The type of essay you're looking for will be provided to you within the deadline offered to you. A descriptive essay presents an individual, place, or thing, in a manner that readers feel as though it's in front of their eyes, or they are tasting it, or they can hear this, or they can smell it. Descriptive essays about a place are common because when referring to a particular place it is normal to attempt to make an experien ce for your reader. The Most Popular Free Descriptive Essay Samples and Examples Now you can get genuine college essay online, one that is going to fit your financial plan and get your work done also. Take pleasure in the procedure for describing the subjectit may be rewarding experience. In your studies there are lots of times when you are going to be needed to spell out a place object person or experience. Cleaning the kitchen or washing the dishes can be considered a process, but they're too ordinary and mundane to compose the entire essay about them. The Basic Facts of Free Descriptive Essay Samples and Examples The value of reading through your essay is the fact that it allows you to spot the mistakes and keep up a superior tone throughout your work. Write background info several explanations for why you're writing the essay. The trick to writing a superb effectiveA essay is to get the passion to write it. Writing a fantastic descriptive essay is basically giving a th orough explanation of a specific feature or phenomenon. As you begin writing more descriptive essays, be certain you paint a photo of your character. Broadly speaking, you should identify three personality traits your character is going to have. Just take a look back to your favourite book and think in what way the characters were revealed to you. In the debut, introduce your character and a few of their traits.

Decision-Making Model Analysis Paper - 1526 Words

Decision-Making Model Analysis Paper Hal E. Bat University Of Phoenix Critical Thinking: Strategies in Decision-Making MGT350 Daryl Korinek Jan 06, 2006 Decision-Making Model Analysis Paper Introduction In order to master critical thinking, the ability to question information and solve problems must be present. The crucial steps that lead to successful decision-making is not based solely on our skills and abilities, but on the strategies that help us get there. All these steps combined allow us to make solid and intelligent decisions. Research on understanding how the mind works is a continuing project at best, but the progress we have made is substantial in the areas of understanding problem-solving and decision-making.†¦show more content†¦I recently had the opportunity to do just that. As part of my PPR, one of my goals was to attend 20 hours of environmental safety courses. During the courses I had learned of several methods used to prevent pollution. One of the discussions centered on a list with subcomponents outlining ways that employees could help to improve the environment and his or her role in preventing pollution. After I had completed the courses I had a meeting with the department manager and discussed the need to educate the employees in our department on environmental safety and pollution prevention. Given the green light to develop a training course, I began working on one specifically designed for my group, which consisted of office workers as well as test well engineers and technicians. I teamed up with a gentleman who worked in software development and we designed an on-line course Environmental Awareness. The topics discussed were disposal of wastes, protection from radiation (we have tools that are made with radiation) by encasing tools with specialized sleeves for storage and shipping, EPA guidelines, recycling and so on. We made it available not only to our department but to all employees of Riordan, both domestic and internationally. I have seen many changes throughout our compound that I know is a direct result of this learning tool. Returning back to Procedural InnovationsShow MoreRelatedDecision Making Of A Bse Veterinary Service846 Words   |  4 PagesDecision Making Companies all over the world are faced with decision daily. Some decisions are small in nature with minimal effects on the company or its employees. While other decisions have a tremendous effect on the entire company. This paper will provide a detailed description of the top three ways to make decisions, such as the rational model, the organizational process model, and the collaborative model. Also, provide some techniques for making decisions. 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