A Quasi-Experimental Controlled Educational Intervention for Mothers To Reduce Unnecessary Emergency Department Admissions in Children with Respiratory Tract Infection Symptoms

Year 2024, Volume: 16 Issue: 1, 1 - 10, 14.03.2024

İkbal Hümay Arman Kübra Temel Aslan Yusuf Arman Çiğdem Apaydın Kaya

https://doi.org/10.18521/ktd.1353592

Abstract

Objective:Although children presenting with respiratory tract infection (RTI) symptoms can be managed by in primary care, these symptoms are the most common reasons for children to present to the emergency department(ED). The aim of this study is to investigate the effect of the education given to mothers by their family physician in reducing the unnecessary admissions of children with RTI symptoms to the ED.
Method:A quasi-experimental, single-blinded, controlled educational intervention study was conducted with the mothers of 6 months–6 years old children. Family Medicine Units were randomized as control and intervention group. Sociodemographic features, admissions to ED, fever-related practices were questioned and a questionnaire including propositions on Knowledge, Attitude and Behaviour (KAB) about RTI symptoms (KABaRTIS) were applied in both groups before-after the intervention. Intervention group received one-to-one, face-to-face education focusing on home management of acute RTI symptoms and alarm findings, also a booklet was given. No intervention was made to the control group.
Result:Study was completed with 178 mothers(Control:118, Intervention:60). The KABaRTIS scores of the mothers increased significantly in both groups(Control:76.9-82.2;p<0.001; Intervention:76.9-83.6;p<0.001), but the delta scores between groups was not significant(p=0.193). The median number of admissions to ED due to RTI symptoms decreased for both groups(p=0.180). However, ED admissions due to severity increased in Control-group and decreased in Intervention-group.
Conclusion:This is the first educational intervention conducted in Primary Care in Türkiye to reduce unnecessary emergency department admissions with RTI symptoms in children. Nevertheless, population characteristics, interventional properties, contamination bias or Hawthorne effect may have reduced the expected effect.

Keywords

family practice, signs and symptoms, pediatric emergency medicine, unnecessary, respiratory tract infections

Ethical Statement

The research was conducted according to the guidelines laid down in the Declaration of Helsinki. The manuscript is in line with the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals. Institutional ethics approval was received from Marmara University, and informed consent was obtained. The privacy rights of the participants were always observed. This manuscript, including related data and tables has not been previously published or currently submitted elsewhere. Researchers conformed to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals, prepared by the International Committee of Medical Journal Editors (ICMJE). This original article is extracted from the main researcher’s Family Medicine master’s thesis in Marmara University, School of Medicine, the Department of Family Medicine, İstanbul, Türkiye.

Supporting Institution

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Solunum Yolu Enfeksiyonu Belirtileri Gösteren Çocukların Gereksiz Acil Servis Başvurularını Azaltmak İçin Annelere Yönelik Yarı Deneysel Kontrollü Bir Eğitim Müdahalesi

Abstract

Amaç: Solunum yolu enfeksiyonu (SYE) semptomları ile başvuran çocuklar birinci basamakta tedavi edilebilmesine rağmen, bu semptomlar çocukların acil servise başvurmasının en yaygın nedenidir. Bu çalışmanın amacı, annelere aile hekimleri tarafından verilen eğitimin, SYE semptomları olan çocukların acil servise gereksiz başvurularını azaltma ve SYE hakkındaki bilgi, tutum ve davranışların geliştirilmesine etkisini araştırmaktır.
Metod: Yarı deneysel, tek kör, kontrollü bir eğitim müdahalesi 6 ay-6 yaş arası çocukların anneleri ile yürütülmüştür. Aile Hekimliği birimleri kontrol ve müdahale grubu olarak randomize edilmiştir. Sosyodemografik özellikler, SYE semptomları nedeniyle acil servise başvurular, ateşle ilgili uygulamalar sorgulanmış ve SYE semptomları hakkında Bilgi, Tutum ve Davranış (BTD) önermelerini içeren bir anket müdahale öncesi ve sonrasında her iki gruba da uygulanmıştır. Müdahale grubuna akut SYE semptomlarının ve alarm bulgularının evde yönetimine odaklanan bire bir, yüz yüze eğitim ile bir broşür verilmiştir. Kontrol grubuna herhangi bir müdahalede bulunulmamıştır.
Bulgular: Çalışma 178 anne ile tamamlanmıştır (Kontrol: 118, Müdahale: 60). Annelerin BTD puanları her iki grupta da anlamlı olarak artmıştır (Kontrol: 76.9-82.2; p<0.001; Müdahale: 76.9-83.6; p<0.001), ancak grupların delta puanları arasında anlamlı fark yoktur (p=0.193). SYE semptomları nedeniyle acil servise yapılan başvuruların ortanca sayısı her iki grup için de azalmıştır (p=0.180). Ancak, hastalık şiddeti nedeniyle acil servise başvurular Kontrol grubunda artarken Müdahale grubunda azalmıştır.
Sonuç: Bu çalışma, çocuklarda SYE semptomları ile gereksiz acil servis başvurularını azaltmak için Türkiye'de Birinci Basamakta yürütülen eğitim müdahalelerinin ilkidir. Bununla birlikte, popülasyon özellikleri, müdahale özellikler, bulaşma yanlılığı veya Hawthorne etkisi beklenen etkiyi azaltmış olabilir.

Keywords

aile hekimliği, belirti ve bulgular, çocuk acil servisi, gereksiz, solunum yolu enfeksiyonları

References

• 1.Republic of Türkiye, Ministry of Health, General Directorate of Public Hospitals. Public Hospitals Statistical Report, 2017 [Internet]. Türkiye; Ministry of Health; 2018. [cited 2023 Sep 11] Available from: https://khgmistatistikdb.saglik.gov.tr/Eklenti/21853/0/kamu-hastaneleri-istatistik-raporu--2017pdf.pdf
• 2. Uscher-Pines L, Pines J, Kellermann A, Gillen E, Mehrotra A. Deciding to visit the emergency department for non-urgent conditions: A systematic review of the literature. Am J Manag Care. 2013;19(1):47-59.
• 3. Yılmaz AA, Köksal AO, Özdemir O, Yılmaz Ş, Yıldız D, Koçak M, et al. An evaluation of cases presenting to the pediatric emergency department of a training and research hospita. Turkish Journal of Pediatric Disease. 2015;1:18-21.
• 4. Turkish Statistical Institute (TÜİK). Türkiye Health Survey 2022, [Internet]. Türkiye: Turkish Statistical Institute (TÜİK); 01.06.2023 [cited 2023 Sep 11] Available from: https://data.tuik.gov.tr/Bulten/Index?p=Turkiye-Saglik-Arastirmasi-2022-49747
• 5. Anıl M, Anıl AB, Köse E, Akbay S, Helvacı M, Aksu N. The Evaluation of the Patients Admitted to the Pediatric Emergency Department in a Training and Research Hospital. J Pediatr Emerg Intensive Care Med. 2014;1(2):65-71.
• 6. Griffey RT, Kennedy SK, D'Agostino McGowan L, Goodman M, Kaphingst KA. Is low health literacy associated with increased emergency department utilization and recidivism? Acad Emerg Med. 2014;21(10):1109-15.
• 7. Ersel M, Karcıoğlu Ö, Yanturalı S, Yürüktümen A, Sever M, Tunç MA. Emergency Department utilization characteristics and evaluation for patient visit appropriateness from the patients’ and physicians’ point of view. Turkish Journal of Emergency Medicine. 2006;6(1):25-35.
• 8. Phelps K, Taylor C, Kimmel S, Nagel R, Klein W, Puczynski S. Factors associated with emergency department utilization for nonurgent pediatric problems. Arch Fam Med. 2000;9:1086-92.
• 9. Vedovetto A, Soriani N, Merlo E, Gregori D. The burden of inappropriate emergency department pediatric visits: why Italy needs an urgent reform. HSR: Health services research. 2014;49(4):1290-1305.
• 10. Benahmed N, Laokri S, Zhang WH, Verhaeghe N, Trybou J, Cohen L, et al. Determinants of nonurgent use of the emergency department for pediatric patients in 12 hospitals in Belgium. Eur J Pediatr. 2012;171:1829–37.
• 11. Herman AD, Mayer GG. Reducing the use of emergency medical resources among Head Start families: a pilot study. Journal of Community Health. 2004;29(3):197-208.
• 12. Peetoom KK, Smits JJ, Ploum LJ, Verbakel JY, Dinant GJ, Cals JW. Does well-childcare education improve consultations and medication management for childhood fever and common infections? A systematic review. Arch Dis Child. 2017;102(3):261-7.
• 13. Başak O, Saatçi E, translation editors. Family Medicine Europe Definition, Wonca Europe 2002 Edition Turkish Translation [Internet]. 1st ed. Türkiye: Turkish Association of Family Physicians (TAHUD) Press; 2003 Jun [cited 2023 Sep 21]; p. 13-41. Available from: https://www.woncaeurope.org/file/8d3167f6-a844-414d-bde4-21ce347e9e9c/2002%20WONCA%20definition%20Turkish%20version.pdf
• 14. National Health System of United Kingdom. Respiratory Tract Infections Conditions [Internet]. United Kingdom: National Health System of United Kingdom; 2021. [cited 2023 Sep 11]. Available from: https://www.nhs.uk/conditions/respiratory-tract-infection/
• 15. Medscape. Pediatrics: General Medicine [Internet]. United States of America: Medscape; 2022 [cited 2023 Sep 11]. Available from: https://emedicine.medscape.com/pediatrics_general
• 16. Pappas, DE. The common cold in children: Clinical features and diagnosis [Internet]. United States of America: UpToDate; 2022. [cited 2023 Sep 11]. Available from: https://www.uptodate.com/contents/the-common-cold-in-children-clinical-features-and-diagnosis
• 17. Kronman MP, Smith S. Section 16. Infectious diseases. In: Marcdante KJ, Kliegman RM, editors. Nelson Essentials of Pediatrics. 7th Edition. International Edition. Philedephia, PA (USA): Elsevier Saunders; 2015. p. 316-63.
• 18. Braunholtz DA, Edwards SJ, Lilford RJ. Are randomized clinical trials good for us (in the short term)? Evidence for a "trial effect". J Clin Epidemiol. 2001;54(3):217-24.
• 19. Simmons N, Donnell D, Ou S, Celentao DD, Aramrattana A, Davis-Vogel A, et al. Assessment of contamination and misclassification biases in a randomized controlled trial of a social network peer education intervention to reduce HIV risk behaviors among drug users and risk partners in Philadelphia, PA and Chiang Mai, Thailand. AIDS Behav. 2015;19(10):1818–27.
• 20. Tilgren P, Dignan M, Michielutte R. Assessment of Contamination in a Trial of Community-Based Cancer Education. American Journal of Health Behavior. 1998;24(4):292–7.
• 21. Rhoads CH. The implications of "contamination" for experimental design in education. Journal Of Educational and Behavioral Statistics. 2011;36(1):76-104.
• 22. Sturm JJ, Hirsh D, Weselman B, Simon HK. Reconnecting patients with their primary care provider: an intervention for reducing nonurgent pediatric emergency department visits. Clinical Pediatrics. 2014;53(10):988 –94.
• 23. Lepley BE, Brousseau DC, May MF, Morrison AK. Randomized Controlled Trial of Acute Illness Educational Intervention in the Pediatric Emergency Department: Written Versus Application-Based Education. Pediatr Emerg Care. 2020;36(4):e192-8.
• 24. Fieldston ES, Nadel FM, Alpern ER, Fiks AG, Shea JA, Alessandrini EA. Effects of an education and training intervention on caregiver knowledge of nonurgent pediatric complaints and on child health services utilization. Pediatric Emergency Care. 2013;29(3):331-6.
• 25. Harvey H, Reissland N, Mason J. Parental reminder, recall and educational interventions to improve early childhood immunization uptake: A systematic review and meta-analysis. Vaccine. 2015;33(25):2862-80.
• 26. Kelly M, Sahm L, McCarthy S, O ’Sullivan R, Mc Gillicuddy A, Shiely F. Randomised controlled trial of an intervention to improve parental knowledge and management practices of fever. BMC Pediatr. 2019;19:447.
• 27. Cooper-Sood JB, Chan C, Cho CS. A paper-based car seat safety educational intervention in the pediatric emergency department. Pediatr Emerg Care. 2021;37(12):e784-7.
• 28. Baker MD, Monroe KW, King WD, Sorrentino A, Glaeser PW. Effectiveness of fever education in a pediatric emergency. Pediatr Emerg Care. 2009;25(9):565-8.
• 29. Turkish Statistical Institute, (TÜİK). National Educational Statistics Database [Internet]. Türkiye: Turkish Statistical Institute, (TÜİK); 2022 [cited 2023 Sep 11]. Available from: https://biruni.tuik.gov.tr/medas/?kn=130&locale=tr
• 30. Kurt F, Beğde F, Oğuz S, Tekin D, Suskan E. How important are parental age and educational level in nonurgent admissions to the pediatric emergency department? Pediatr Emerg Care. 2020;36(9):414-8.
• 31. O'Neill-Murphy K, Liebman M, Barnsteiner JH. Fever education: Does it reduce parent fever anxiety? Pediatr Emerg Care. 2001;17(1):47-51.
• 32. Franco SM, Mitchell CK, Buson RM. Primary care physician access and gatekeeping: a key to reducing emergency department use. Clin Pediatr. 1997;36(2):63-8.
• 33. Petersen LA, Burstin HR, O’Neil AC, Orav EJ, Brennan TA. Nonurgent emergency department visits: the effect of having a regular doctor. Med Care. 1998;36:1249-55.
• 34. Morgan SR, Chang AM, Alqatari M, Pines JM. Non–emergency department (ed) interventions to reduce ed utilization: A systematic review. Acad Emerg Med. 2013;20(10):969–85.