Document Details
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Document Type |
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Article In Journal |
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Document Title |
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Quality of Care of Children With Chronic Diseases in Alexandria, Egypt: The Models of Asthma, Type I Diabetes, Epilepsy, and Rheulualic Heart Disease Quality of Care of Children With Chronic Diseases in Alexandria, Egypt: The Models of Asthma, Type I Diabetes, Epilepsy, and Rheulualic Heart Disease |
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Document Language |
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English |
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Abstract |
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Objectives. To evaluate the quality of
care delivered to children suffering from index chronic
diseases using specific indicators of health care delivery
and to study the predictors of suboptimal quality of care
(SQC) and its outcome on children.
lJesigll. Over a 9-month period, guidelines for optim.
ll care were formulated. A specific questionnaire for
every studied chronic disease was prepared in collaboralion
with the clinicians in charge of the diseased children
(66% pediatricians and pediatric specialists and 34%
adult specialists). The clinicians were asked to write the
details of daily practice, ie, how these children were
managed on a routine basis as well as in an emergency
situation. A cross-sectional study was conducted over a
4-l1\onth period and included 953 children suffering from
bronchial asthma (BA), childhood epilepsy (Cm, type I
diabetes mellitus (100M), and rheumatic heart disease
mHO). A systematic random sample of children was
sdected from children visiting the ambulatory settings of
all children's hospitals. Every fourth child was selected
on 2 randomly chosen days each week, while all diseased
children admitted in the hospital settings of the children's
hospitals during the study were included.
A general form describing the impact of the diseases
on the child was prepared. A network of clinicians was
created in all children's hospitals; seminars were held
during which the content validity of the questionnaire
W.1Stested. Items were evaluated for their internal consistency
using the Cronbach a.
According to the degree of adherence to the recent
therapeulic guidelines concerning selected indicators of
the quality of care specific to every disease, children were
categorized as receiving optimal quality of care or SQC.
These indicators were: the use of inhaled bronchodilators
in acute asthmatic attacks in mild asthma and the use of
the prophylactic drugs (inhaled sodium cromoglycate or
inhaled beclomethasone) in moderate to severe chronic
UA in between acute asthmatic attacks; compliance with
antiepileptic drugs in epileptic children; regular performance
of self-monitoring of blood glucose and/or urine
I
Fruin th~ 'o.,p,utn1l'nt of M~odk,\1Statistics. Medical Research Instilute,
i\l,'x.\lI5 F.I-Horreya A,'e, EI-Hadar". Alexandrl., Egypt. E-mail:
.1ma Ie ,ti.~y a hOt.).c,1111
l'EDlIlTRICS (ISSN 01131 41XJ5),Copyright Ii:>2000 by the Americ'lII Ac.\d-
,'my I..r P"',,li.ltrics.
testing in diabetic children; and compliance with prophylactic
antibiotics in children suffering from RHO.
The records of the outpatient clinics for ambulatory
and hospitalized cases were reviewed to assess the degree
of compliance with the prescribed management before
the'index visit.
Sociodemographic characteristics and health care system-
related predictors of SQC were analyzed via stepwise
logistic regression analysis.
The impact of illness on the child was assessed by 7
items which were: dependence on parenls in domestic
activities, level of activity compared with peers, mood
compared with peers, level of socializing, degree of discomfort
attributable to illness, level of physical disadvantage,
and urinary incontinence. Factor 'analysis with
Varimax rotation was performed on items related to the
impact of illness.
Parental satisfaction with care was rated as excellent,
very good, fair, or poor. Information on schoQI outcome
was obtained by asking the caretakers whether the child
was able to attend school regularly despite his sickness.
Scholastic achievement was also rated as excellent, very
good, good, and acceptable. Parents were asked whether
the child had ever repeated a grade because o~ his sickness,
.
Settillg. Ambulatory and hospital settings ~'all children's
hospitals in Alexandria, Egypt.
Results. Only 52% of mild asthmatics were given inhaled
bronchodilators during acute attacks and 6.84% of
moderate to severe asthmatics were taking prophylactic
drugs (inhaled sodium cromoglycate and/or inijaled. beclomethasone)
between acute aHacks. Similarly, only 53
of 134 (39.6%) of diabetic children were regul~rly performing
self-monitoring of blood glucose and/or urine
testing. In contrast, in epileptic children, 121 of 173
(69.9%) were judged as being compliant by their managing
clinicians and more than two thirds 82/123 «i6.7'Yq)of
children with RHD were compliant with the !recondary
prophylactic antibiotic.
Predictors of SQC were younger age of the child (ill 1.1/\
and CE), lower maternal education (in BA and IOD,M),
charged medication (in BA, 100M, and RHD), suburban
residence (in moderate to severe BA), lower.paternal
education {in cm, and management in healtil facilities
other than university hospital (in 100M).
Regarding the outcome of chronic diseases on children,
lactor analysis revealed 2 lactors (physicat and psychosocial
impact) that cxplaincd 41.5% of variance 1vith moderate
adequacy (Kaiser-Meyer-Olkin test of sampling adequacy
= .67). Oependence on parents in domestic
activities, urinary incontinence, physical disadvanlage, |
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ISSN |
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0031-4005 |
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Journal Name |
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American Academy OF Pediatrics |
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Volume |
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106 |
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Issue Number |
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1 |
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Publishing Year |
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1421 AH
2000 AD |
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Article Type |
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Article |
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Added Date |
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Sunday, April 22, 2012 |
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Researchers
| منى حسن | hassan, mona | Researcher | Doctorate | |
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