November 6, 2013
Caregivers Need More Training to Improve
Asthma Med Delivery

Bronx, NY—The vast majority of children with asthma receive less than optimal care because their caregivers are using incorrect techniques to deliver their medication, according to a new study from The Children's Hospital at Montefiore (CHAM).

More hands-on training by healthcare professionals, such as pharmacists, would help to improve outcomes and reduce hospital admissions and healthcare costs, the authors conclude.

The study, published in the Journal of Asthma, found that only one of 169 caregivers accurately carried out 10 steps to deliver adequate medication for asthma management, as described in treatment guidelines.

For the study, researchers monitored how adults used metered-dose inhaler (MDI) spacer devices to deliver the medication to children in their care. Participating in the investigation were 169 caregivers of urban minority children, from 2- to 9-years-old, who had persistent asthma requiring daily administration of medication via an inhaler.

According to the study, 95% of the participants were mothers, averaging about 32-years-old, with a majority (56%) unemployed. Of the children in their care, 74% of whom were Hispanic, 87% had either “not well controlled” or “very poorly controlled” asthma. Yet 92% had a spacer at home and 71% used it “all” or “most” of the time.

Using a 10-step checklist, researchers rated the technique “good” if seven or more steps were conducted accurately but rated technique “poor” if six or fewer steps were correctly followed. The study notes that five of the 10 steps were considered essential for adequate delivery of the medications.

“As only one caregiver could do all steps accurately and fewer than 4% were able to complete five essential steps, we believe that regular education efforts would be beneficial to caregivers and their children,” said lead author Marina Reznik, MD, MS, a pediatrician at CHAM, and assistant professor of pediatrics at Albert Einstein College of Medicine. “We also learned that caregivers whose children had been admitted for asthma in the past year were more likely to exhibit correct use, suggesting they had been retrained during the hospitalization and as a result were better able to perform the steps.”

Caregivers were questioned about control of the children’s asthma and whether they had received instructions—including a demonstration—by a medical professional on proper administration of the medication.

While more than 90% of the caregivers said they had received a verbal explanation of how to administer the medication, only 54% said they were asked by a medical professional to demonstrate that they could actually do it themselves.

“Our study results further support the fact that caregivers need regular demonstration and evaluation of the correct technique, which could lead to improved clinical outcomes as well as reduced hospitalizations and healthcare costs,” Reznik pointed out. “We want to keep our kids healthy and education will help make that happen.”

U.S. Pharmacist Social Connect