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Mémoires Année : 2016

Parental knowledge and effects of an early educational intervention about asthma in the pediatric emergency department of University Hospital of Bordeaux

Connaissances parentales et effets d’une intervention éducative précoce dans l’asthme aux urgences pédiatriques du CHU de Bordeaux

Résumé

Background: Asthma is the most frequent chronic condition for children in France, causing an increasing number of hospitalizations and visits in emergency departments. Lack of medical follow-up and insufficient patient education are frequent reasons why asthma remains poorly controlled. Visits in the emergency department represent an opportunity to include asthmatic children and their families in a healthcare circuit preventing future exacerbations and visits in hospital. Considering this, we conducted a study which objectives were to assess parental knowledge about childhood asthma after a visit in the emergency department and to examine the effects of an early telephonic educational intervention on the readmission rates in the emergency department. Methods: Population was recruited in the pediatric emergency department of the University Hospital of Bordeaux. We included patients aged from 6 months to 18 years, consulting for asthma between 10/21/2015 and 01/11/2016 and going home after the consult. Data about diagnosis, treatment and childhood asthma-related parental knowledge was collected through a first standardized telephone interview within the 8 days following the visit in the emergency department. At the end of it, oral and written educational information about asthma was delivered. Parents were contacted again 4 months later in order to collect data regarding asthma control, treatment, follow-up and parental knowledge. Hospitalizations and visits to the emergency department were considered during the 6 months following the first visit for both included patients and patients who met the inclusion criteria during the recruitment phase but could not be included. Results: Among the 313 patients who consulted in the emergency department for asthma during the recruitment phase, 40 patients were included. There was an increase in hospitalization (p = 0,04) and reconsultation (p < 0,001) rates for non-included patients during the 6 months following the first visit in the emergency department whereas those rates remained stable for included patients. Yet, there were no statistically significant difference in hospitalization rates (12,5% for included patients and 8,8% for non-included patients) and in reconsultation rates (respectively 17,5% and 17,6%) between the 2 groups during the 6 months period. And in both groups, parents were significantly less ready to face an asthma attack 4 months after the visit in the emergency departments than in the first 8 days, except for those who participated in patient education in individual or collective sessions. Conclusion: An early educational intervention permits to stabilize readmission rates for children consulting in an emergency department for asthma. Further studies are needed to increase educational dimension of asthma management and to offer a standardized healthcare circuit for every asthmatic children visiting the emergency department.
Introduction : L’asthme de l’enfant génère un nombre croissant d’admissions aux urgences. L’éducation thérapeutique, dans le cadre d’un suivi régulier, est un des éléments clés de sa prise en charge et fait pourtant souvent défaut. Nous avons mené une étude dans l’objectif de décrire les connaissances parentales et les effets d’une intervention éducative précoce sur le devenir des enfants asthmatiques consultant aux urgences pédiatriques. Matériel et méthodes : Menée dans le service des urgences pédiatriques du CHU de Bordeaux d’octobre 2015 à juillet 2016, l’étude visait à recueillir, au moyen d’entretiens téléphoniques standardisés, les connaissances des parents sur l’asthme de leur enfant afin de leur délivrer un complément d’information adapté, puis à évaluer secondairement le taux de réadmission dans les six mois suivant une consultation aux urgences. Résultats : Parmi les 313 patients consultant pour asthme dans la phase d’inclusion, 40 patients ont été inclus. Il n’y avait pas de différence statistiquement significative entre les taux de reconsultation, de respectivement 17,5% et 17,6% chez les patients inclus et non inclus, et d’hospitalisation, de respectivement 12,5% et 8,8%, dans les six mois. Ils étaient statistiquement stables chez les patients inclus et augmentaient significativement chez les patients non inclus au cours des six mois. Conclusion : Une intervention éducative précoce peut permettre de stabiliser les taux de réadmission dans les suites d’une consultation pour asthme aux urgences pédiatriques. Davantage de travaux sont nécessaires afin d’accroître la part de l’éducation thérapeutique dans le cadre d’un parcours de soins durable dès les urgences pédiatriques.
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Dates et versions

dumas-01398116 , version 1 (16-11-2016)

Identifiants

  • HAL Id : dumas-01398116 , version 1

Citer

Mélanie Joseph. Connaissances parentales et effets d’une intervention éducative précoce dans l’asthme aux urgences pédiatriques du CHU de Bordeaux. Médecine humaine et pathologie. 2016. ⟨dumas-01398116⟩
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