Poor Caregiver Knowledge Leads to Prolonged Hospital Stays in Pediatric Asthma

Deepti Deshpande, MD, MPH

Children with asthma whose caregivers have poor knowledge of their condition are 4 times more likely to experience prolonged hospital stays than those whose caregivers who have adequate knowledge of the condition and its management, according to new research presented at the American College of Allergy, Asthma and Immunology annual meeting in Seattle, WA.

In the study, led by Deepti Deshpande, MD, MPH, of Arizona University, a prolonged hospital stay was defined as any stay more than 2 days. After adjusting for age, baseline asthma control, pediatric ICU stay, parental education, payer and ethnicity, investigators found that children of caregivers with poor asthma knowledge were 4 times as likely to have a prolonged hospital stay than those with adequate knowledge (OR=4.44; 95% CI 1.075-18.34). Researchers defined poor caregiver knowledge as anyone who achieved a score of 1-4/6 on the Likert scale on questions about medications and triggers.

In the study, investigators monitored 73 children between the ages of 2 and 17 years who were hospitalized with asthma exacerbations between December 2012 and December 2013. Their caregivers completed questionnaires at the time of admission, then again at discharge, and once more 4 to 6 weeks after discharge.

During their child’s hospital stay, the patients’ caregivers and family members received education in the form of interactive asthma materials that covered general asthma knowledge, as well as a demonstration of correct inhaler technique.

Investigators found that caregiver knowledge may predict the length of stay in children who are hospitalized with asthma exacerbations, and that caregiver knowledge can be improved after on-site education at the hospital. After inpatient education, caregivers demonstrated an increase in general asthma knowledge (P=.002) between admission and the 4-6 week follow up period. Moreover, 90% and 73% of caregivers were able to correctly name their child’s rescue and controller medicines, respectively, at the 4-6 week follow up.

“We focused on providing families with a better understanding of medications, their use, side effects and correct technique for use of devices to help improve use,” Deshpande said. “After the education program, caregivers showed an increase in their general asthma knowledge from admission to 4 to 6 weeks after discharge. Additionally, at 4 to 6 weeks after discharge, 90% of caregivers were able to correctly name their child’s rescue medicine and 73% were correctly able to name the controller medicines.”

Investigators suggested that further prospective studies should examine whether improved caregiver knowledge can reduce length of stay and health care services utilization.

Similar studies have found that it’s not only caregivers who are short on knowledge for conditions that require inhalers like asthma and chronic obstructive pulmonary disease (COPD). A large European study found that less than 40% of patients were able to perform a perfect inhalation, regardless of the type of their inhalation device (these can vary in size, length of treatment administration, spacer optimization, and storage requirements, among other things). Other studies have suggested direct correlations between incorrect inhaler use and COPD patient symptom control.

When working with patients who require inhalers, “keep those patient factors at the top of your mind,” said Jill Ohar, MD, of Lexington Medical Center at Wake Forest Baptist, at a presentation at the CHEST annual meeting in Toronto last year. “It’s not just the drug — it’s the drug and the device.”