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Understanding interventions delivered in the emergency department targeting improved asthma outcomes beyond the emergency department: an integrative review

Skene, I, Kinley, E, Pike, K, Griffiths, C, Pfeffer, P and Steed, L (2023) Understanding interventions delivered in the emergency department targeting improved asthma outcomes beyond the emergency department: an integrative review. BMJ Open, 13 (8). ISSN 2044-6055

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Objectives The emergency department (ED) represents a place and moment of opportunity to provide interventions to improve long- term asthma outcomes, but feasibility, effectiveness and mechanisms of impact are poorly understood. We aimed to review the existing literature on interventions that are delivered in the ED for adults and adolescents, targeting asthma outcomes beyond the ED, and to code the interventions according to theory used, and to understand the barriers and facilitators to their implementation. Methods We systematically searched seven electronic databases and research registers, and manually searched reference lists of included studies and relevant reviews. Both quantitative and qualitative studies that reported on interventions delivered in the ED which aimed to improve asthma outcomes beyond management of the acute exacerbation, for adolescents or adults were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool and informed study interpretation. Theory was coded using the Theoretical Domains Framework. Findings were summarised by narrative synthesis. Results 12 articles were included, representing 10 unique interventions, including educational and medication- based changes (6 randomised controlled trials and 4 non- randomised studies). Six trials reported statistically significant improvements in one or more outcome measures relating to long- term asthma control, including unscheduled healthcare, asthma control, asthma knowledge or quality of life. We identified limited use of theory in the intervention designs with only one intervention explicitly underpinned by theory. There was little reporting on facilitators or barriers, although brief interventions appeared more feasible. Conclusion The results of this review suggest that ED- based asthma interventions may be capable of improving long- term outcomes. However, there was significant variation in the range of interventions, reported outcomes and duration of follow- up. Future interventions would benefit from using behaviour change theory, such as constructs from the Theoretical Domains Framework.

Item Type: Article
Uncontrolled Keywords: 1103 Clinical Sciences; 1117 Public Health and Health Services; 1199 Other Medical and Health Sciences
Subjects: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > RA Public aspects of medicine
Divisions: Psychology (from Sep 2019)
Publisher: BMJ Publishing
SWORD Depositor: A Symplectic
Date Deposited: 23 May 2024 14:03
Last Modified: 23 May 2024 14:15
DOI or ID number: 10.1136/bmjopen-2022-069208
URI: https://researchonline.ljmu.ac.uk/id/eprint/23359
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