Enhancing Patient Care

Transcription

1 Enhancing Patient Care I CAN control my asthma! PHYSICIAN WEB ORIENTATION COMMUNITY PEDIATRIC ASTHMA SERVICE JULY 2014

2 Sorry we couldn't connect in person This presentation will inform Calgary Zone physicians about: The Community Pediatric Asthma Service and what your patients will learn in an asthma education appointment with a Certified Respiratory Educator (CRE) How to refer for Asthma Education Our follow-up documentation: Asthma Education Summary Preliminary assessment of spirometry Asthma Action Plan

3 3 Simple Steps to Refer 1. View this presentation. Feel free to contact us if you have any questions/concerns at Complete the attached Physician Orientation Payment form and fax it to our office. We will add your name to our list of physician partners and you will receive our annual two-page Physician Newsletter/Update 3. Refer a patient for asthma education as soon as you identify one. Our CREs will do the rest! 3

4 Burden of Asthma System Physician diagnosed asthma estimated to affect more than 45,000+ children in the Calgary Zone Personal/Family 15% of all children have asthma (1 in 6) More than half of all the children and adults with asthma do NOT have well-controlled asthma Asthma Society of Canada,

5 Asthma Is Controlled* When You Have No daytime symptoms No nighttime symptoms No limits to normal physical activity No missed school or work No need for reliever medication except occasionally for exercise *Global Initiative for Asthma (GINA), Asthma Management and Prevention in Children, December

6 Reasons for Lack of Asthma Control No objective measure of control (spirometry) - over/under estimate control Insufficient patient education Misunderstand effect of asthma medications Over use of combination therapies Under use of anti-inflammatory medications inadequate dose intermittent use poor adherence Lack of follow-up 6

7 Canadian Asthma Consensus Guidelines (CACG) 2012 Control environment Asthma education Self-management Written Asthma Action Plan First line anti-inflammatory therapy for all ages is inhaled corticosteroids (ICS) If asthma not optimally controlled on low/medium dose ICS, consider: Increasing ICS dose (preferred for <12 years) Adding a leukotriene receptor antagonist (preferred for <12 years) Combining ICS with long-acting beta-agonist (preferred for >12 years) 7

8 Asthma Education Makes a Difference! Even with a 13% increase in the Zone pediatric population, asthma visits to ED and inpatient admissions at Alberta Children s Hospital in are the #9 and #7 reason for presentation, down from #3 and #3 in ! Almost a 20% reduction in asthma emergency visits and admissions in to Alberta Children s Hospital & Peter Lougheed Centre great validation for asthma education and management efforts. Child Health Annual Quality & Utilization Reports asthma patients, 18 month pre/post evaluation: 65% decrease in ED visits 62% decrease in hospital days Families and healthcare professionals reported significant increases in knowledge and confidence in asthma management Belfield Resources Inc., Oct

9 Value of Spirometry Objective measurement of lung function Differential diagnosis/confirm diagnosis Evaluate symptoms i.e. cough, SOB, vocal cord dysfunction (VCD) Correlate subjective and objective findings of airways obstruction Important indicator of control Assess severity Screening for COPD in at risk population Asthma is a variable condition so normal spirometry does not rule out asthma 9

10 Spirometry Report Preliminary assessment provided by CRE on test and our Asthma Education Summary Interpretation by pediatric respirologist will follow from Pulmonary Function Lab at Alberta Children s Hospital If critical values are reported, we have a documented process to ensure patient safety 10

11 Peak Flow Monitoring Measures large airways only so not as reliable or accurate as spirometry Late indicator of loss of control so not used as commonly as in the past May be helpful for poor perceivers or to identify workplace triggers 11

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13 Medication Pearls Guidelines recommend: ICS are the first line controller medication Daily maintenance use of ICS, not intermittent use Combination therapy not indicated for initial or intermittent therapy Asthma Action Plan for everyone with asthma Control first, then the lowest dose of medication to maintain control Promote use of spacer with metered dose inhalers (MDI) for all ages Auto-scaling allows for same dose for all ages (Alvesco 100, Flovent 125, Asmanex 200, Pulmicort 200 or Qvar 100) Allow child to choose device. Device errors when all medications are in the same type of device Dry powder devices (diskus, turbuhaler, twisthaler) can be used by 6 years Intermittent leukotrienes (generic montelukast or Singulair) may be useful for asthma triggered by colds in non-atopic preschoolers* *Achieving control of asthma in pre-schoolers, CMAJ Nov 23,

14 Asthma Education Appointment Patients booked for 60 minutes of education with spirometry (6+ years). Follow-up visit(s) as needed Spirometry will be interpreted by a pediatric respirologist and the interpretation will be sent directly to your office Education includes: Review of asthma Identification of triggers and avoidance strategies Barriers to adherence and problem solving Medication differences (action and side effects) Device technique review Written Asthma Action Plan Tobacco prevention/reduction Anaphylaxis review/device demo 14

15 Alberta Asthma Action Plan Asthma Action Plan in Pictures 15

16 Web Tools Kids Patient/Family Teens Health Providers Teachers & Coaches

17 Patient Tools Patient Brochure available in 13 languages

18 Physician Partners Physician orientation (in person or online) is recommended to refer patients (your time is paid) We will fast track your patient to the Asthma Specialty Clinic at Alberta Children s Hospital, if required Asthma Specialty Clinic is aware of our partnership The Community Pediatric Asthma Service is partnered with the Departments of Family Medicine and Rural Medicine 18

19 CRE will Follow-up If Patient would likely benefit from follow-up Patient is unable to maintain control with current Asthma Action Plan Devices and/or medications have changed Abnormal spirometry Seasonal asthma see during troublesome season 19

20 WHERE TO REFER IN CALGARY ZONE Community Pediatric Asthma Service for 60 minutes of asthma education Asthma Specialty Clinic, Alberta Children s Hospital for specialist support Pulmonary Function Lab, Alberta Children s Hospital for testing to support asthma diagnosis Poor control of asthma/spirometry Recent ED visit/admission Multiple ED visits (3+) Review of medications, including compliance and technique Written Asthma Management Plan First or second episode of wheeze Asthma symptoms. Need confirmation of diagnosis Trigger identification and avoidance strategies Family needs more information about asthma Mild to moderate asthma Any ICU admission for asthma Co-morbidities Non-responsive to asthma treatment (explain in comments) 6 18 months of age (If <6 months, refer to Pulmonary Clinic) Psycho/social concerns impacting asthma control Moderate to severe asthma Standard testing includes spirometry lung volumes pre/post bronchodilator for 6+ years Pre-school testing 4 6 years (if developmentally appropriate) Support asthma diagnosis Suspect asthma, but no previous spirometry

21 Tobacco Reduction & Prevention Improving lung health together Are you aware of local smoking cessation resources? Do you have a systematic approach to address smoking with your young patients? Nine years is the age to start asking them if they or their friends smoke or chew tobacco Do you have a strong message for children about the importance of NOT starting smoking? Do you address exposure to tobacco smoke with all your pediatric patients? 21

22 Anaphylaxis People with asthma who are also diagnosed with lifethreatening allergies are more susceptible to severe breathing problems when experiencing an anaphylaxis reaction. It is extremely important for people with asthma to keep their asthma well controlled * *Anaphylaxis in Schools and Other Settings, 2 nd edition, Canadian Society of Allergy and Clinical Immunology, September 2009, pp. 10, 4. We will review use of auto-injectors (Epi-Pen, TwinJect and Allerject) in patients with anaphylaxis 22

23 Anaphylaxis People with asthma who are also diagnosed with lifethreatening allergies are more susceptible to severe breathing problems when experiencing an anaphylaxis reaction. It is extremely important for people with asthma to keep their asthma well controlled * *Anaphylaxis in Schools and Other Settings, 2 nd edition, Canadian Society of Allergy and Clinical Immunology, September 2009, pp. 10, 4. We will review use of auto-injectors (Epi-Pen, TwinJect and Allerject) in patients with anaphylaxis

24 Ready? Set? Go! Fax us your Physician Orientation Payment form Refer with our Patient Referral form available on our website at (see Forms tab) We will call and schedule your patient for asthma education in one of our Community Clinics Immediately following the appointment, we will fax you: Asthma Education Summary Preliminary assessment of spirometry Asthma Action Plan 24

25 How to Contact Us Community Pediatric Asthma Service South Calgary Health Centre (#2270) 31 Sunpark Plaza SE Calgary, AB T2X 3W5 Phone: Our private fax line: Visit our website at: 25