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Written Action Plan for Asthma Attacks - Emergency Setting


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Original and Validated Translations

Non-Validated Translation

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Introduction

The Written Action Plan for asthma attacks is meant to assist in the self-management of patients following a medical consultation for an acute asthma exacerbation.

Objectives

To develop a written self-management plan to be used on discharge from the acute care setting (e.g., walk-in clinic, emergency department, hospital wards) in line with national guideline 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 by health care professionals.

Development and validation

The Written Action Plan (WAP) for asthma attacks was developed using the standard Kirshner and Guaytt's approach for instrument development. The first 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 and one for the usual clinic setting, 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 discharged following an acute care visit for an asthma exacerbation from a walk-in clinic, emergency room, or hospital admission. It focuses on the management of an acute asthma exacerbation [red zone], indicates when to seek urgent care, and calls for a re-assessment by the regular physician and asthma educator to obtain a new action plan to stay in control. Each zone is identified by symptoms and symbolised by traffic light colors.

The Written Action Plan (WAP) for asthma attacks transcends from the traditional concept of former self-management plan in that it clearly identifies the acute care visit as a failure to treatment.

It is intended to assist patients in self-assessing and self-managing their asthma by:

  • Linking the validated Asthma Quiz for Kids and three control zones;
  • Structuring pharmacologic recommendations for the treatment of the exacerbation, the long-term management with daily controller medication, and the recommendation for medical follow-up and asthma education.
  • 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 the 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) for asthma attacks applies to children, adolescents, and, most likely, 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 for asthma attacks settings is currently being used in emergency departments of hospitals across the province of Québec.

Research use

In a placebo-controlled randomised controlled trial, the Written Action Plan (WAP) for asthma attackshas been proven effective to improve the quality of physician’s’ prescription, patient adherence, and patient asthma control over the 30 days following the visit to the emergency room.2

Original and validated language

  • Canadian French
  • Canadian English

Non-Validated Translation

  • Spanish

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, Zemek R, Chalut D, McGillivray D, Noya FJ, Resendes S, Khomenko L, Rouleau R, Zhang X. Written action plan in pediatric emergency room improves asthma prescribing, adherence and control. Am J Resp Crit Care Med. 2011 (183)195-203. 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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