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Written Action Plan for Asthma


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Original and Validated Translations

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Introduction

The Written Action Plan (WAP) for clinical settings is meant to assist in the self-management of patients’ asthma following a clinic medical visit.

Objectives

To develop a written self-management plan to be used in the clinic setting, in line with national guidelines recommendations:

  • Based on scientific evidence and expert opinions;
  • Facilitating self-assessment by linking the Asthma Quiz for Kids and control zones;
  • Perceived as relevant and clear by asthmatic children, adolescents, and adults;
  • Designed to facilitate its uptake and dispensing by health care professionals.

Development and validation

The Written Action Plan (WAP) was developed using the standard Kirshner and Guaytt's approach for instrument development. The initial prototype was inspired by self-management plans in randomised controlled trials, two surveys of asthma educators in the United Kingdom and Quebec, international expert opinions, and the 2004 Canadian Asthma Guidelines. The initial prototype was tested for clarity with cognitive interviews and revised in an iterative fashion by 97 parents and their asthmatic children aged 1 to 17 years. The versions were revised until 85% clarity and perceived relevance were obtained. Two versions emerged, one for the usual clinic setting and one for the acute care setting. After feedback, the final versions were approved by La Direction scientifique du suivi et de l’usage optimal du Conseil du Médicament and its committees, our international consultant committee, and expert groups. Using the back-translation technique, we simultaneously designed and tested the French and English versions.

Instrument

This tool is specifically designed for patients who are seen by their treating physician for a medical visit. It focuses on the maintenance of asthma control [green zone], the appropriate measures to take in case of deterioration [yellow zone] and when to seek urgent care [red zone]. Each zone identified by symptoms and symbolised by traffic light colors.

The Written Action Plan (WAP) transcends from the traditional concept of former self-management plan in that it clearly provides a template for both pharmacologic and non-pharmacologic management of asthma. It is intended to assist patients in self-assessment and self-management of their asthma by:

  • Linking the result obtain on the validated Asthma Quiz for Kids with one of the three control zones;
  • Structuring the pharmacologic recommendations along with national recommendations to maintain and/or regain asthma control;
  • Promoting non-pharmacologic approaches to manage asthma control recommended by the Canadian Asthma Consensus (e.g. seeking help from pharmacists and asthma educators (asthma education), avoiding asthma triggers (environmental control), taking medication as prescribed (compliance), retaking the Asthma Quiz for Kids (self-assessment), and seeing their doctor regularly (regular medical review)).

In addition, three features were intended to facilitate dispensing of the self-management plan by physicians and asthma educators namely the:

  1. Use of the “fill-in-the-blank” method to reduce the amount of writing;
  2. Design as an educational tool; and
  3. Triplicate document where:
    • The prescription is the first copy;
    • The replica for the medical chart is the second copy;
    • The self-management plan for the patient is the third copy.

The Written Action Plan (WAP) applies to children, adolescents, and also to adults; it is available in French and English, and is offered as a communication tool between patients and health care professionals (physicians, pharmacists, asthma educators).

Clinical use

The Written Action Plan (WAP) for clinical settings is currently being used in hospitals and clinics across the province of Québec.

Contact Person: Patricia Côté, Réseau québécois de l’enseignement sur l’asthme et la MPOC [Quebec Network for asthma and COPD education]: www.rqam.ca.

Original and validated language

  • Canadian French
  • Canadian English

References

  1. Ducharme FM, Noya F, McGillivray D et al. Two for one: a self-management plan coupled with a prescription sheet for children with asthma. Can Respir J.2008;15(7):347-354. http://www.ncbi.nlm.nih.gov/pubmed/18949103
  2. Ducharme FM, Bhogal SK. The role of written action plans in childhood asthma. Curr Opin Allergy Clin Immunol. 2008;8(2):177-188. http://www.ncbi.nlm.nih.gov/pubmed/18317029

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Updated on 6/1/2016
Created on 6/1/2016
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