A Group Visit for High-Risk Pediatric Asthma Patients Improves Parent Confidence

Abstract

Purpose: Asthma disproportionately affects poor and minority children. Limited parental knowledge and confidence in asthma management, as well as stress from chronic illness may contribute to poor outcomes. Novel approaches for providing care are essential for this vulnerable population. As part of a quality improvement initiative, we developed and implemented a pilot asthma group visit to: 1) evaluate the feasibility of the group visit format for high risk children with asthma, 2) assess parents’ experiences with the group visit, and 3) assess the impact of participation on parents’ confidence in asthma management. Methods: Our primary care practice provides care for over 2,600 children with asthma. Many have public insurance. Children classified as high-risk (≥1 asthma-related emergency department visit/hospitalization in the preceding two years) were eligible to participate. During the group visit, children received brief physical exams, medication reviews, and updated Asthma Action Plans (AAPs). Separate educational sessions were held for children and parents. Pre- and post-group visit surveys were used to assess parents’ experience and changes in confidence in asthma management. Results: Twenty children and their parents participated. Mean parent confidence scores (five-point Likert scale, 5 indicating greatest confidence) improved in: managing their child’s asthma symptoms (3.60, 4.40 p≤ 0.005), managing their child’s asthma medications (3.85, 4.30 p ≤0.005), using their child’s AAP (3.79, 4.45 p≤ 0.02), communicating with the school about their child’s food allergies (4.32, 4.72 p≤0.03), and helping their child relax to reduce emotional triggers of asthma (3.25, 4.47, p≤0.01). All families reported that they would return to a group visit. Conclusion: Group visits are feasible for providing care, education, and peer support to a vulnerable population. Parents expressed satisfaction and improved confidence in aspects of asthma management. Group visits have the potential to engage high-risk families and improve asthma health outcomes.