Document Details

Document Type : Article In Journal 
Document Title :
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
 
Document Language : English 
Abstract : 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, 
ISSN : 0031-4005 
Journal Name : American Academy OF Pediatrics 
Volume : 106 
Issue Number : 1 
Publishing Year : 1421 AH
2000 AD
 
Article Type : Article 
Added Date : Sunday, April 22, 2012 

Researchers

Researcher Name (Arabic)Researcher Name (English)Researcher TypeDr GradeEmail
منى حسنhassan, mona ResearcherDoctorate 

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