ArticleShared Medical Appointments: Facilitating Care for Children With Asthma and Their Caregivers
Section snippets
Background and Literature Review
The effective treatment of pediatric asthma strains the resources of primary care settings. The efforts of health care providers to control asthma are clearly inadequate. A review of the literature confirms that the number and severity of asthma cases in children is increasing (American Academy of Allergy, Asthma and Immunology, 2008, American Lung Association, 2007, Centers for Disease Control and Prevention & National Institutes of Health, 2006). In addition, asthma is a growing problem for
Theoretical Framework
It has long been established that the concepts of (a) parental participation in children's health care, (b) partnership and collaboration between the health care team and parents in decision making, (c) family-friendly environments that normalize as much as possible family functioning within the health care setting, and (d) care of family members as well as of children is critical to the successful management of asthma (Bursch, Schwankovsky, Gilbert, & Zeiger, 1999; Franck & Callery, 2004).
Shared Medical Appointment Program Setting
The SMA program was introduced to Harvard Vanguard Medical Associates (HVMA) in December 2007. HVMA is a non-profit, multispecialty medical group practice that provides care to more than 450,000 adult and pediatric patients at more than 20 offices across eastern Massachusetts.
HVMA physicians, challenged to adopt a new model of care, implemented the first adult SMA in January 2008 in the Internal Medicine Department to provide the physicians with tools to solve access, service, and quality of
Results
Eighteen-year-old patients and caregivers of patients younger than 18 years responded to questions about their level of satisfaction with several aspects of the SMA. Frequency distributions were run to examine the satisfaction items. Responses measuring satisfaction can be found in Table 2, Table 3, Table 4. The survey was voluntary, and 30 of the 39 caregiver/patient dyads, including one of two 18-year-old patients, returned the survey.
A 5-point Likert-type scale (“poor,” “fair,” “good,” “very
Conclusion
Although managing any chronic illness is time consuming, studies have shown that incorporating illness concerns in well visits may improve chronic illness management (Looman, O'Conner-Von, & Lindeke, 2008). However, obstacles cited by physicians that affect delivery of care are the same as those identified by NPs in primary care (Van Leuven & Prion, 2007). By improving access to regular visits for patients with asthma, the SMA provides opportunities for introducing and anticipating illness
Constance L. Wall-Haas, Pediatric Nurse Practitioner, Harvard Vanguard Medical Associates, Chelmsford, MA.
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Constance L. Wall-Haas, Pediatric Nurse Practitioner, Harvard Vanguard Medical Associates, Chelmsford, MA.
Pamela Kulbok, Associate Professor of Nursing, University of Virginia School of Nursing, Charlottesville, VA.
John Kirchgessner, Assistant Professor of Nursing, University of Virginia School of Nursing, Charlottesville, VA.
Virginia Rovnyak, Senior Scientist, University of Virginia School of Nursing, Charlottesville, VA.
Conflicts of interest: None to report.