poster EAACI
1
Sebastiano Guarnaccia, Mariateresa Chiarini, Alessandro Gaffurini, Andrea Lombardi, Emanuele D'Agata, Giusy Boldini, Adriana Boldi, Raffaele Spiazzi S. Guarnaccia ([email protected] ) Centro “Io e l‟Asma”, Laboratorio Clinico Pedagogico e Ricerca Biomedica, Spedali Civili, Brescia, Italy www.ioeasma.it "Io e l'Asma", a clinical asthma management programme developed over a period of ten years, implementing international guidelines into daily practice AIMS To analyse the evolution and the adherence of the “Io e l'Asma” programme implementing International Asthma Guidelines based on the clinical pathway for children over a period if ten years. STUDY PROGRAM 1999−2002 The pulmonologist is the sole responsible for all aspects of the management: diagnosis , therapy, education and follow−up. The primary care physician and the nurse are merely supportive. An educational book and a CD−ROM are made available for patients and families. 2003−2005 A holistic approach is developed with a team of specialists (pulmonologist, resident, nurse, clinical pedagogue, web−engineer) working on its own without co−ordination or a shared plan. A diagnostic therapeutic protocol based on the International Guidelines is developed with primary care physicians. 2006−2008 All team members now create a framework following a sheduled diagnostic−therapeutic− clinical pathway (basis: 3 specialist visits at 0, 6−8, 12−16 weeks, followed by 6−monthly visits). RESULTS A total of 1140 consecutive children aged 1 to 15 participated in the three periods above mentioned. The average number of patients for year, in the 1999−2002 and 2003− 2005 is 57 and 121; the number of patients in the 2006, 2007 and 2008 are 145, 168, 176 respectively. The mean number of specialist visits was 2.2 and 3.2 in the first and second periods and consequently the mean length of follow−up was 2.3 and 5.85 months. The mean length of follow−up for 2006, 2007 and 2008 was respectively 5.04, 3.63 and 3.85 months. The drop−out rate was 60.4% and 19.5% in the first 2 periods; in 2006 it was 18.1%, in 2007, 17. 3% and in 2008 an outstanding 4.5%. CONCLUSIONS “Io e l„Asma”, which implements international guidelines, shows how following a structured pathway (three specialist visits in the third period) reduced absenteeism drastically. As a result, patient and family adherence increased significantly and had a highly favorable effect on daily management. 1999-2002 2003-2005 2006-2008 0 1 2 3 4 5 6 Mean length of follow−up 0% 10% 20% 30% 40% 50% 60% 70% 1999−2002 2003− 2005 2006 2007 2008 Drop−out rate 0 20 40 60 80 100 120 140 160 180 Number of patients
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poster at the EAACI 2009
Transcript of poster EAACI
Sebastiano Guarnaccia, Mariateresa Chiarini, Alessandro Gaffurini, Andrea Lombardi, Emanuele D'Agata, Giusy Boldini, Adriana Boldi, Raffaele Spiazzi
S. Guarnaccia ([email protected]) Centro “Io e l‟Asma”, Laboratorio Clinico Pedagogico e Ricerca Biomedica, Spedali Civili, Brescia, Italy
www.ioeasma.it
"Io e l'Asma", a clinical asthma management programme
developed over a period of ten years, implementing
international guidelines into daily practice
AIMS
To analyse the evolution and the adherence of the “Io e l'Asma” programme
implementing International Asthma Guidelines based on the clinical
pathway for children over a period if ten years.
STUDY PROGRAM
1999−2002
The pulmonologist is the sole responsible for all aspects of the
management: diagnosis , therapy, education and follow−up.
The primary care physician and the nurse are merely supportive.
An educational book and a CD−ROM are made available
for patients and families.
2003−2005
A holistic approach is developed with a team of specialists
(pulmonologist, resident, nurse, clinical pedagogue,
web−engineer) working on its own without co−ordination or a
shared plan. A diagnostic therapeutic protocol based on the
International Guidelines is developed with
primary care physicians.
2006−2008
All team members now create a framework following a
sheduled diagnostic−therapeutic− clinical pathway (basis:
3 specialist visits at 0, 6−8, 12−16 weeks, followed
by 6−monthly visits).
RESULTS
A total of 1140 consecutive children aged 1 to 15 participated in
the three periods above mentioned. The average number of
patients for year, in the 1999−2002 and 2003− 2005 is 57 and
121; the number of patients in the 2006, 2007 and 2008 are 145,
168, 176 respectively. The mean number of specialist visits was
2.2 and 3.2 in the first and second periods and consequently the
mean length of follow−up was 2.3 and 5.85 months.
The mean length of follow−up for 2006, 2007 and 2008 was
respectively 5.04, 3.63 and 3.85 months. The drop−out rate was
60.4% and 19.5% in the first 2 periods; in 2006 it was 18.1%,
in 2007, 17. 3% and in 2008 an outstanding 4.5%.
CONCLUSIONS
“Io e l„Asma”, which implements international guidelines,
shows how following a structured pathway (three specialist
visits in the third period) reduced absenteeism drastically.
As a result, patient and family adherence increased
significantly and had a highly favorable effect on daily
management.
1999-2002
2003-2005
2006-2008
0
1
2
3
4
5
6
Mean length of follow−up
0%
10%
20%
30%
40%
50%
60%
70%
1999−2002 2003− 2005
2006 2007 2008
Drop−out rate
02040
60
80
100
120
140
160
180
Number of patients
