Datasets:

marianna13
/

litarch

+{"file": "techbrief35_NBK556503/ch4.nxml", "text": "Structure and Content of Asthma Self-Management Education Packages\nOur review of 14 asthma self-management education (AS-ME) packages currently available in the United States found that robust packages exist for adults, adolescents, children, and parents of children with asthma. A few widely used packages are designed for use in schools, while numerous packages are intended for implementation in community-based sites, healthcare facilities, patient homes, or all of these settings. A few packages focus on specific asthma populations including Latino patients, women, multicultural or minority communities, or low-income areas. Three packages focused on patients with severe asthma, but we did not identify any packages designed specifically for patients with significant comorbidity.\nMost packages require or offer education facilitated in-person by a trained instructor, while fewer packages rely mainly on self-directed education by a patient at home. In-person programs are usually led by a nurse, school nurse, respiratory therapist, community health worker, or other trained asthma educator. Learning materials are typically paper-based and include workbooks and handouts for patients, and useful tools such as asthma action plans and checklists to identify asthma triggers at home. All packages are available in English and many have been translated into Spanish, but materials are not available in other languages. Most packages are freely accessible and can be downloaded by anyone, but some are only available for a fee. We note that we were unable to access several potentially relevant packages.\nEducational content across AS-ME packages had many similarities, addressing basic knowledge of asthma, medication and device use, symptom management, environmental and behavioral triggers, goal setting, and learner evaluation. However, specific details vary between packages, including techniques for device use or medication guidelines. Most packages were developed or updated in the past 6 years, but older packages may require revision or updating. Additionally, an update to widely disseminated guidelines for asthma care is expected soon and may require review and revision of packages to ensure content is evidence-based.\nImplementation of AS-ME Packages\nImplementation of AS-ME packages varies widely. Instructors often tailor packages to best suit their patients, settings, or available resources, an affirmation of the importance of adaptability for successful packages. Numerous homegrown packages also exist, though we know less about those efforts as they are generally more difficult for the general public to access. Guidance for facilitators also varies, with some packages providing comprehensive instructional manuals while others supply minimal or no instruction. Prominent organizations including the American Lung Association, Asthma and Allergy Foundation of America, and Association of Asthma Educators, offer online or in-person courses to prepare educators to implement AS-ME. Three packages we reviewed were train-the-trainer programs intended specifically for clinicians, community health workers, and other asthma educators.\nMost packages were developed or are disseminated by a small number of leading professional or patient advocacy organizations. Little is known about the financial resources, staffing, and time needed to develop AS-ME packages. Many of the packages currently available were funded in part by government agencies, especially the Centers for Disease Control and Prevention.\nEffectiveness of AS-ME Packages\nWe identified a substantial evidence base assessing the effectiveness of AS-ME in the United States. Our searches identified 7 systematic reviews published since 2007, as well as 16 randomized controlled trials, 16 observational studies, and 1 descriptive study. Half of published studies evaluated school-based packages, while community- or hospital-based packages accounted for most of the remainder. Only a few studies examined home-based interventions. Similarly, three-quarters of the studies were conducted in child and/or adolescent populations, while far fewer studies focused on adult patients. Most studies occurred in communities with large racial and/or ethnic minority populations and low markers of socioeconomic status.\nOutcomes most frequently reported in primary studies were asthma knowledge, asthma-related quality of life, and asthma symptoms. Numerous studies also reported asthma-related hospitalizations, emergency department use, and asthma control. Few studies examined asthma-related school absences, use of maintenance or rescue medications, or avoidance of asthma triggers. In general, AS-ME packages were associated with improved asthma control, reduced symptom frequency, increased asthma knowledge, and fewer school absences. Results across the studies were mixed when examining hospitalizations, emergency department visits, and quality of life.\nOnly 4 of 14 AS-ME packages included in this Technical Brief were evaluated in the research studies we identified. Instead, nearly half of studies examined homegrown AS-ME packages, which we were unable to access. However, of the studies assessing four packages evaluated in this Technical Brief, 7 of 8 studies found that AS-ME packages were associated with substantial improvement in key outcomes.\nNext Steps\nDevelopers and Disseminating Organizations can:\naddress patient population needs by expanding translation of AS-ME materials to audiovisual components and additional languages; indicating the literacy level required for comprehension; designing packages for learners with differing learning styles; and developing packages for patients across the spectrum of asthma severity and with substantial comorbidityensure current content through revision and updatinginform future AS-ME initiatives by sharing data on costs, staffing, and time needed for development, testing, and disseminationexpand availability of materials by reducing or eliminating barriers to accessimprove cross-pollination of ideas and foster innovation by sharing homegrown approachesinvest in technological platforms that can expand the reach of AS-ME packages in a variety of ways, including web-based programs, mobile apps, and telehealthimprove usability by identifying components of a package that may require specific skills or knowledge by a facilitatordevelop content to address the challenges of managing asthma across different settings and coordinating care among across providers and caregivers\naddress patient population needs by expanding translation of AS-ME materials to audiovisual components and additional languages; indicating the literacy level required for comprehension; designing packages for learners with differing learning styles; and developing packages for patients across the spectrum of asthma severity and with substantial comorbidity\nensure current content through revision and updating\ninform future AS-ME initiatives by sharing data on costs, staffing, and time needed for development, testing, and dissemination\nexpand availability of materials by reducing or eliminating barriers to access\nimprove cross-pollination of ideas and foster innovation by sharing homegrown approaches\ninvest in technological platforms that can expand the reach of AS-ME packages in a variety of ways, including web-based programs, mobile apps, and telehealth\nimprove usability by identifying components of a package that may require specific skills or knowledge by a facilitator\ndevelop content to address the challenges of managing asthma across different settings and coordinating care among across providers and caregivers\nResearchers can:\naddress patient population needs by evaluating AS-ME packages designed for adult asthma patients; increase study of home-based, community-based and self-directed packages; routinely report asthma severity, comorbidity, and socioeconomic factors in published studies; and examine how patient literacy/health literacy, cultural competence of AS-ME educators/providers, and social determinants of health influence the use and effectiveness of AS-ME packagesexamine the extent to which current AS-ME packages are being used, for all asthma patients and among higher risk subgroupsdescribe and evaluate how packages are modified and adapted to local circumstancesimprove the rigor of outcome reporting by including standard measures of asthma control and absenteeism, and developing methods to more effectively assess and report medication use and trigger avoidancestrengthen the body of evidence for AS-ME packages by researching packages that have not been widely studied, and conducting head-to-head studies that compare packages to other packages and to other widely used interventionsexamine how current evidence could guide development of model AS-ME packages for different audiences and patient populations\naddress patient population needs by evaluating AS-ME packages designed for adult asthma patients; increase study of home-based, community-based and self-directed packages; routinely report asthma severity, comorbidity, and socioeconomic factors in published studies; and examine how patient literacy/health literacy, cultural competence of AS-ME educators/providers, and social determinants of health influence the use and effectiveness of AS-ME packages\nexamine the extent to which current AS-ME packages are being used, for all asthma patients and among higher risk subgroups\ndescribe and evaluate how packages are modified and adapted to local circumstances\nimprove the rigor of outcome reporting by including standard measures of asthma control and absenteeism, and developing methods to more effectively assess and report medication use and trigger avoidance\nstrengthen the body of evidence for AS-ME packages by researching packages that have not been widely studied, and conducting head-to-head studies that compare packages to other packages and to other widely used interventions\nexamine how current evidence could guide development of model AS-ME packages for different audiences and patient populations\nPolicymakers can:\nsupport new research and development with increased and new funding sourcespromote training for asthma educators and other instructional facilitators by exploring payment models to reimburse their servicesfoster innovation by supporting the coordination of strategic efforts by developers to share data and ideasamplify the work of developers and disseminators through the nation\u2019s public health infrastructureencourage and guide standardization or alignment of AS-ME components across packages to enable more efficient implementation\nsupport new research and development with increased and new funding sources\npromote training for asthma educators and other instructional facilitators by exploring payment models to reimburse their services\nfoster innovation by supporting the coordination of strategic efforts by developers to share data and ideas\namplify the work of developers and disseminators through the nation\u2019s public health infrastructure\nencourage and guide standardization or alignment of AS-ME components across packages to enable more efficient implementation", "pairs": [], "interleaved": []}
+{"file": "techbrief35_NBK556503/ch1.nxml", "text": "Background\nAsthma is a chronic respiratory syndrome characterized by airway inflammation and a variety of symptoms including coughing, wheezing, and shortness of breath. More than 8 percent of both adults and children in the United States have asthma, and in 2016 asthma accounted for 1.7 million emergency department visits and more than 3,500 deaths.1 Asthma can significantly reduce patients\u2019 and families\u2019 quality of life and affects attendance at school, work, and participation in recreational activities. Half of adults and nearly 40 percent of children report poorly controlled or uncontrolled asthma, although a wide variety of pharmacological and other interventions are available to improve asthma control and reduce the frequency and burden of symptoms.2\nPatients and families can play a substantial role in minimizing the burden of asthma through careful medication management, reducing exposure to environmental triggers, and responding rapidly to exacerbations.3 However, understanding the complex interaction between respiratory physiology, asthma triggers, short- and long-term medications, and rescue therapies requires significant education and training that may be challenging for patients and caregivers. Clinical practice guidelines developed by the National Heart, Lung and Blood Institute therefore emphasize formal and comprehensive asthma self-management education (AS-ME) as a key component of optimal asthma care.4 National standards for AS-ME have been published,5 and the Centers for Disease Control and Prevention (CDC) recently introduced a new technical package aimed at improving asthma control, EXHALE, that highlights AS-ME as a vital strategy within a continuum of approaches to improve asthma care. EXHALE describes AS-ME as a strategy to teach\n\u201c\u2026basic facts about asthma, roles of medications, how to use medications correctly, what to do when asthma symptoms worsen, and how to reduce exposure to asthma triggers\u2026Effective AS-ME can be delivered in a variety of settings (e.g., individual, family, or group education in a clinic, school, pharmacy, or community) by a variety of providers (e.g., nurses, respiratory therapists, certified asthma educators, or community health workers) \u2026[and] requires repetition and reinforcement.\u201d6\n\u201c\u2026basic facts about asthma, roles of medications, how to use medications correctly, what to do when asthma symptoms worsen, and how to reduce exposure to asthma triggers\u2026Effective AS-ME can be delivered in a variety of settings (e.g., individual, family, or group education in a clinic, school, pharmacy, or community) by a variety of providers (e.g., nurses, respiratory therapists, certified asthma educators, or community health workers) \u2026[and] requires repetition and reinforcement.\u201d6\nDozens of AS-ME packages have been developed and disseminated by various organizations and agencies, and many packages or their components have been examined in controlled studies. A recent review of reviews3 synthesized the findings of 27 systematic reviews encompassing 270 randomized controlled trials of AS-ME approaches. The authors found that AS-ME improves asthma control and reduces healthcare utilization, and can be implemented for diverse populations in varying settings. Other recent reviews have also suggested the value of AS-ME for improving asthma outcomes7 and quality of life.8\nDespite the widespread use and evaluation of AS-ME packages, there remains uncertainty about their optimal design, characteristics, and implementation. Heterogeneity in content, format, delivery mechanisms, targeted populations, and other features complicates efforts to identify best practices in designing packages. Additionally, different populations and types of learners may need different educational approaches and strategies. As the prevalence and burden of asthma remain high,1,2 there is increasing interest by clinical experts, patient advocates, public health leadership, and policymakers to identify and invest resources in effective interventions. Future packages would benefit from a structured framework delineating the current state of AS-ME practice, knowledge, and research.\nThis Technical Brief mapped the ecosystem of current AS-ME packages. We identified the different components that comprised selected AS-ME packages that are used in the United States, and examined, compared, and organized their key characteristics to enable a better understanding of current practice. We summarized important elements of their scope, design, content, and target audience, and included evidence, when available, addressing their effectiveness, feasibility, and user satisfaction. Our analysis also highlighted factors affecting implementation, including public availability and cost, user literacy, mode of delivery, and ease of use. Finally, we identified key gaps in knowledge about optimal AS-ME packages, and illuminated the practical challenges to future work in this field.\nGuiding Questions\nGQ 1: What are the characteristics of AS-ME packages, and how do they vary?\n\n\nAudience\n\n\nWho is included in the intended audience?\nAre packages focused on, or limited to, specific patient characteristics?\nWhat level of literacy is required? Are packages offered in multiple languages?\n\n\nDelivery and use of AS-ME packages\n\n\nWhat is the setting for delivery of education?\nIs education self-directed, or delivered by an instructor (if so, whom)?\nWhat aspects of the package are interactive?\nWhat mediums are used to deliver education and facilitate communication?\nWhat is the timeframe?\nHow are packages initially accessed? Is there a clinical gatekeeper (e.g., referral or login permission needed)?\n\n\nEducational content\n\n\nWhat key content areas are addressed?\nHow do packages address cognitive, psychological, and/or emotional components of asthma and asthma self-management?\nWhat tools are provided to recipients as components of the packages?\nWhat evidence supports the validity of the content? Does the content align with national asthma guidelines?\nWhen were the packages designed/updated?\nAre explicit educational goals identified? How is individual learning/progress evaluated?\nGQ 2: What is the context and implementation of AS-ME packages?\nWho develops the packages?\nAre packages publicly available? Is there a fee? Are they protected by copyright?\nHow much does it cost to develop, produce, promote, disseminate, and use packages?\nWho pays for educational packages?\nDo recipients earn a certification of completion?\nIs there a process to sustain/support retention of learning over time?\nWhat factors are important facilitators and barriers to implementation of AS-ME?\nHow is technology used to support implementation?\nIf education is guided by an instructor, how are instructors identified and trained?\nAre current/future workforce resources adequate to provide instruction?\nHow is implementation evaluated?\nGQ 3: What is the current evidence addressing AS-ME packages?\nWhat asthma outcomes are measured? Are packages associated with good outcomes?\nWhat patient-centered outcomes are measured? Are packages associated with good outcomes?\nWhat implementation outcomes are measured? Are packages associated with good outcomes?\nHow applicable is current evidence to various populations and settings?\nGQ 4: What future research is needed to close evidence gaps regarding AS-ME packages?\nWhat additional evaluation is needed on existing AS-ME packages?\nAre different evaluation approaches needed to assess AS-ME?\nWhat new types of packages, or components and features of packages, may be needed?\nIs further evaluation needed focusing on specific patient populations? Are some populations not adequately addressed by current packages?", "pairs": [], "interleaved": []}
+{"file": "techbrief35_NBK556503/appd.nxml", "text": "Asthma self-management education packages: characteristics\nAsthma self-management education packages: structure and content\nSystematic reviews of asthma self-management education\nRandomized controlled trials of asthma self-management education packages\nObservational studies of asthma self-management education packages", "pairs": [], "interleaved": []}