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Measuring Disease Burden: Asthma caregiver quality of life. Ana Kobayashi Maternal and Child Health Program June 7, 2006. Background. Asthma is a major public health problem facing children and families.

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Measuring disease burden asthma caregiver quality of life l.jpg

Measuring Disease Burden:Asthma caregiver quality of life

Ana Kobayashi

Maternal and Child Health Program

June 7, 2006


Background l.jpg

Background

  • Asthma is a major public health problem facing children and families.

  • Asthma is a common chronic childhood illness, leading to 14 million missed school days each year.

  • Children’s asthma also affects the well - being of parents and caregivers.

(National Center for Environmental Health of the Centers of Disease Control and Prevention, 2005) (Institute of Medicine, 2000)


Asthma caregiver quality of life l.jpg

Asthma Caregiver Quality of Life

  • The Pediatric Asthma Caregiver Quality of Life Questionnaire (PACQLQ) measures how a child’s asthma affects caregivers.

  • 13 item questionnaire asking caregivers about their activities and feelings.

(Juniper et al., 1996b)


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Literature Review

  • Patient QOL studies find that AQLQ scores are related to:

    • Asthma severity

    • Environmental tobacco smoke (ETS)

    • Education and income

    • Female gender (inconsistently)

    • Hispanic race/ethnicity

(Leidy et al., 1998a, Leidy et al., 1998b;Eisner et al, 2002;Sippel et al., 1999) (Adams et al., 2004; Apter et al, 1999; von Rueden et al., 2006)


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Literature Review

  • Few studies have investigated predictors of caregiver QOL, and indicate caregiver QOL is associated with:

    • Child symptom free days and symptom frequency

    • Caregiver’s perception of disease control

    • Use of maintenance medication

    • Smoking household

    • Hispanic ethnicity

(Halterman et al., 2004; Levy et al., 2004)


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Study Objective

  • To evaluate relationships between caregiver QOL and health utilization, asthma management, and other variables in a community sample.


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Setting: Clean Air for Kids

  • Clean Air for Kids Partnership (CAFK) is a program designed to help caregivers of children with asthma learn how to manage asthma at home and how to reduce environmental exposures.

  • Caregivers of children with asthma who live in Pierce County, Washington reach the program through community-, physician-, school-, and self - referral.

(Primomo, Johnston, DiBiase, Nodolf & Noren, 2006)


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Methods

  • Secondary data analysis

  • Data was collected during CAFK program evaluation, consisting of baseline caregiver survey responses.

  • Linear regression was used to evaluate associations between independent and outcome variables and to generate three linear regression models.


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Results

  • Found:

    • Associations between independent variables and PACQLQ, Emotional function, and Activity limitation scores.

    • Three stepwise linear regression models for each: PACQLQ, Emotional function, and Activity limitation scores.


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Results


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Implications for practice

  • Interventions proven to reduce emergency health services utilization should be used to support increased caregiver quality of life.

  • Future studies should further investigate relationships between demographic characteristics of families and caregiver quality of life.


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Acknowledgements

  • Clean Air for Kids Partnership

  • Janet Primomo RN, PhD.

  • Marcia Williams PhD., MPH.

    Supported in part by Project #T76 MC 00011

    from the Maternal and Child Health Bureau

    (Title V, Social Security Act),

    Health Resources and Services Administration,

    U.S. Department of Health and Human Services.


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References

Adams R.J., Wilson D., Smith B.J., & Ruffin R.E. (2004) Impact of coping and socioeconomic factors on quality of life in adults with asthma. Respirology 9: 87-95.

Adams R.J., Appleton S., Wilson D.H., & Ruffin R.E. (2005) Participatory decision making, asthma action plans, and use of asthma medication: A population survey. Journal of Asthma, 42:673 – 678.

Apter A.J., Reisine S.T., Affleck G., Barrows E., & ZuWallack R.L. (1999) The influence of demographic and socioeconomic factors on health – related quality of life in asthma. J Allergy Clin Immunol, 103(1): 72 – 78.

Barnes N.C., & Williams A.E. (2005) Unscheduled healthcare resource use among asthma patients receiving low – dose inhaled corticosteroids maintenance treatment. Int J Clin Pract, 59(9): 1017 – 1024.

Eisner M.D., Yelin E.H., Katz P.P, Earnest G & Blanc P.D. (2002). Exposure to indoor combustion and adult asthma outcomes: Environmental tobacco smoke, gas stoves, and woodsmoke. Thorax, 57: 973-978.


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References

Erickson S.R., Christian Jr. R.D., Kirking D.M., & Halman L.J. (2002) Relationship between patient and disease characteristics, and helath – related quality of life in adults with asthma. Respiratory Medicine, 96: 450-460.

Halterman J.S., Yoos H.L., Conn K.M., Callahan P.M., Montes G., & et al. (2004) The Impact of childhood asthma on parental quality of life. Journal of Asthma 41(6): 645-653.

Institute of Medicine (IOM) (U.S.). (2000). Clearing the air: asthma and indoor air exposures. Washington, D.C: National Academy Press.

Juniper E.F., Guyatt G.H., Feeny D.H., Ferrie P.J., Griffith L.E. & Townsend M. (1996a). Measuring quality of life in children with asthma. Quality of Life Research 5: 35-46.

Juniper E.F., Guyatt G.H., Feeny D.H, Ferrie P.J., Griffith L.E, & Townsend M. (1996b) Measuring quality of life in the parents of children with asthma. Quality of Life Research 5: 27-34.

Krieger J.W., Takaro T.K., Song L., & Weaver M. (2005) The Seattle – King County Healthy Homes Project: A randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. American Journal of Public Health, 95(4): 652 – 659.


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References

Kurnat E.L., Moore C.M. (1999) The impat of a chronic condition on the families of children with asthma. Pediatric Nursing, 25 (3): Career and Technical Education pg 288.

Leidy N.K, Chan K.S., & Coughlin C. (1998) Is the asthma quality of life questionnaire a useful measure for low – income asthmatics? Am J Respir Crit Care Med 158: 1082-1090.

Leidy N.K., & Coughlin C. (1998) Psychometric performance of the Asthma Quality of Life Questionnaire in a US sample. Quality of Life Research 7: 127-134.

Leung R., Koenig J.Qu., Simcox N., van Belle G., Fenske R., & Gilbert S.G. (1997) Behavioral changes following participation in a home health promotional program in King County, Washington. Environ Health Perspect. 105(10): 1132-5.

Levy J.I., Welker – Hood L.K., Clougherty J.E., Dodson R.E., Steinbach S., & et al. (2004) Lung function, asthma symptoms, and quality of life for children in public housing in Boston: a case – series analysis. Environmental health: A Global Access Science Source 3 (13).


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References

Medical Assistance Administration. (2005). Medical Eligibility Overview. Accessed online May 2006 at http://fortress.wa.gov/dshs/maa/eligibility/OVERVIEW/MedicalOverviewChildrens.htm.

Meszaros A, Zelko R, Mesko A, & Vincze Z. (2005) Factorial design for the analysis of patient’s quality of life in asthma. Qual Life Res 14: 191-195.

National Asthma Education and Prevention Program (NAEPP). (2002). National Asthma Education and Prevention Program Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma—Update on Selected Topics 2002. (2002). National Heart, Lung, and Blood Institute, National Institutes of Health, NIH Publication No. 97-4051: Bethesda, MD. Retrieved September 19, 2005 from http://www.nhlbi.nih.gov/guidelines/asthma/index.htm

National Asthma Education and Prevention Program (NAEPP). (2006). National Asthma Education and Prevention Program: Program Description. Accessed online May 2006 at: http://www.nhlbi.nih.gov/about/naepp/naep_pd.htm.

National Center for Environmental Health of the Centers for Disease Control and Prevention. (2005) “Asthma's Impact on Children and Adolescents." Retrieved June 2005, from: http://www.cdc.gov/asthma/children.htm


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References

Primomo J., Johnston S., DiBiase F., Nodolf J., & Noren L. (2006). Evaluation of a community – based outreach worker program for children with asthma. Public Health Nursing, 23(3): 234 - 241.

Schatz M, Mosen D, Apter A.J., Zeiger R.S., Vollmer W.M, et al. (2005) Relationships among quality of life, severity, and control measures in asthma: An evaluation using factor analysis. J Allergy Clin Immunol, 115(5): 1049-1055.

Sippel J.M., Pedula K.L, Vollmer W.M., Buist A.S., & Osborne M.L. (1999). Associations of smoking with hospital - based care and quality of life in patients with obstructive airway disease. Chest, 115: 691 - 696

von Rueden U., Gosch A., Rajmil L., Bisegger C., Ravens – Sieberer U., & the European Kidscrren group. (2006) Socioeconomic determinants of health related quality of life in childhood and adolescence: Results from a European study. J. Epidemiol. Community Health, 60: 130-135.


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Questions?


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