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Adherence to guidelines for drug treatment of asthma in children: potential for improvement in Swedish primary care.

https://arctichealth.org/en/permalink/ahliterature122367
Source
Qual Prim Care. 2012;20(2):131-9
Publication Type
Article
Date
2012
Author
Maria Ingemansson
Björn Wettermark
Eva Wikström Jonsson
Maria Bredgard
Marina Jonsson
Gunilla Hedlin
Anna Kiessling
Author Affiliation
Paediatric Department, Astrid Lindgrens Hospital, Karolinska University Hospital, Sweden.
Source
Qual Prim Care. 2012;20(2):131-9
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy
Child
Child, Preschool
Female
Guideline Adherence
Humans
Infant
Male
Physician's Practice Patterns - statistics & numerical data
Primary Health Care
Quality of Health Care
Sweden
Abstract
Adherence to guidelines in general is poor. Because asthma is the most common chronic disease in Swedish children, identifying areas for improvement regarding drug treatment for asthma is crucial.
To explore the utilisation patterns of anti-asthmatic drugs in children with asthma in relation to evidence-based guidelines.
All children visiting 14 primary healthcare centres in Stockholm, Sweden, who had their first prescription of anti-asthmatic agents dispensed between July 2006 and June 2007 were followed over 24 consecutive months. The children (1033 in total) were divided in two age groups: 0-6 years and 7-16 years. The outcome measurements were: the characteristics of the physicians initiating drug treatment; the extent to which the children were initiated on the drugs recommended in the guidelines; and the amount and frequency of drugs dispensed over time and whether the dosage texts on the prescriptions contained adequate information.
In 54% of the older children and 35% of the younger children, only one prescription for anti-asthmatic drugs was dispensed during two years of follow-up following the first prescription. In school-aged children, 50% were initiated on inhaled short-acting bronchodilating beta2-agonists (SABA) in monotherapy. Among preschool children, 64% were initiated on SABA and inhaled corticosteroids in combination. In 41% of the prescriptions dispensed, the indication was stated and in 25% the mechanism of action was stated. Drug therapy was initiated by a general practitioner in 42% of the younger children and 72% of the older children.
There is a need for improvement in adherence to guidelines in important areas. Asthma, especially among children aged 7-16 years, is usually a chronic disease and should, in many cases, be treated with anti-asthmatics counteracting inflammation. However, this was not the case in our study. In addition, the dosage texts written by the physicians did not follow recommendations and may negatively influence patient safety.
PubMed ID
22824566 View in PubMed
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Medicine use and disease control among adolescents with asthma.

https://arctichealth.org/en/permalink/ahliterature277665
Source
Eur J Clin Pharmacol. 2016 Mar;72(3):339-47
Publication Type
Article
Date
Mar-2016
Author
Elin Dahlén
Björn Wettermark
Anna Bergström
Eva Wikström Jonsson
Catarina Almqvist
Inger Kull
Source
Eur J Clin Pharmacol. 2016 Mar;72(3):339-47
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy
Cross-Sectional Studies
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Self Report
Sweden
Treatment Outcome
Abstract
Pharmacological treatment is a cornerstone in asthma management, but there is limited evidence on how adolescents use their medication and to what extent their asthma is under control. Therefore, the aim of this study was to compare self-reported and register-based medicine use in asthmatic adolescents. Furthermore, we investigated the association between medicine use, patient characteristics, and degree of asthma control.
Cross-sectional analyses of 331 adolescents with asthma from a population-based birth cohort linked to data from the Swedish Prescribed Drug Register. Adolescents' asthma medicine use was assessed with three approaches: self-reported medicine use, self-reported use of someone else's medicines, and dispensed medicines from pharmacies during an 18-month period. Medicine use in adolescents with and without asthma control were compared.
In total, 82% reported use of asthma medicines, 10 % reported use of someone else's medicines, and 62% were dispensed asthma medicines from pharmacies. Among adolescents with self-reported medicine use, 22% (n = 60) were neither dispensed medicines nor using someone else's medicines. The majority of those using someone else's medicines had also been dispensed asthma medicine (22 out of 33). Among adolescents with asthma, 176 were fully controlled and 155 were uncontrolled. Also, boys had higher odds of having asthma control than girls.
Most adolescents with asthma reported use of asthma medicines, but a considerable proportion were neither dispensed any medicines nor using someone else's medicines. Girls were less likely to achieve asthma control. It is important to combine data sources to understand medicine use among adolescents with asthma.
PubMed ID
26671238 View in PubMed
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