Keeping Kids Out of the Hospital

According to a study published last year, thousands of children's hospitalizations could be avoided each year if parents were better educated about their child's illness. The study included two groups of physicians - primary care and inpatient attending physicians - and 554 hospitalized children with a median age of 4 years old. The most common reasons for hospitalization of the children were asthma (43%), dehydration/gastroenteritis (16%), pneumonia (11%), seizure disorder (8%), and skin infections (8%).

The study was led by Glenn Flores, MD, FAAP, Medical College of Wisconsin Associate Professor of Pediatrics, Epidemiology and Health Policy; Director of Community Outcomes, Department of Pediatrics; and Director of the Center for the Advancement of Underserved Children. The results of the study pointed out the importance of parents learning all they can about their child's condition in order to avoid unnecessary hospitalization.

"Our study findings suggest that inadequate education of parents about their child's condition can contribute to the child being hospitalized for a condition that could have been prevented," says Dr. Flores. "Both physician groups and parents agreed that better education of parents by pediatric healthcare providers could have prevented many hospitalizations."

Of the parents surveyed in the study, 25% thought their child's hospitalization could have been prevented, compared with 29% of the primary care physicians and 32% of the inpatient attending physicians. Dr. Flores explains, "This may reflect inadequate education of parents by the child's healthcare provider, resulting in some parents believing that there is nothing one can do to prevent a child's hospitalization, when, in fact, prevention is possible."

Medication Issues Dominate
Parents of the children in the study said the single most common reason for avoidable hospitalizations was their lack of adherence to medication-related issues. Dr. Flores explains these issues: "The major medication issues revealed by the study included: ensuring adequate medication adherence, including instruction on proper dosages, dose frequency, treatment duration, and how to efficiently obtain needed refills," he says.

Dr. Flores says that parents should carefully review the following with their child's healthcare providers:

• each medication's name and its purpose
• the medication's dosage, and dose frequency
• how to give the medication
• how long to take the medication
• whether refills are being provided with the prescription
• how to refill the medication
• whom to call should the child run out of medication

Preventive Measures are Most Effective
Parents in the study also acknowledged that they did not take appropriate preventive measures to keep their children out of the hospital. These included keeping healthy children away from sick children, helping children with asthma avoid triggers like cigarette smoke and dust, and making sure sexually active adolescents use condoms.

Regarding adolescents, the study showed that teenagers between 15 and 18 years of age showed the highest proportion of avoidable hospitalizations in the study. Dr. Flores says, "This question deserves further study, but we know from prior studies that adolescents have the lowest adherence of any age group of children."

In addition, "the parents and the adolescent may believe that the adolescent has a better understanding of the condition and medications than the adolescent actually has. Finally, studies indicate that adolescents have the lowest use of health services and are most likely to miss appointments."

Follow-Up Visits
Another issue pointed out in the study was the importance of follow-up visits. Both groups of physicians cited delayed or no follow-up visits as a major contributor to avoidable hospitalizations, but parents in the study cited this reason significantly less often. This suggests that parents need to be better educated on the need for and importance of follow-up visits. Again, it is vital that physicians and parents work together on advising and scheduling future visits, so the patient's health is properly and continuously monitored.

A Note about Asthma
Asthma was the illness that caused the highest frequency of hospitalizations. At 43% of admissions, it was by far the most common diagnosis. According to the US Centers for Disease Control and Prevention (CDC), it is the third leading cause of hospitalization among children under 15 years old, with over 6 million children currently living with asthma in the US.

Equipment like nebulizers and inhalers play an important part in asthma treatment, and equipment failure was cited in some of the study's avoidable hospitalizations, giving parents and caregivers of children with asthma patients one more important issue to be aware of.

Dr. Flores sums up the study's results: "Our key conclusion is a simple action point that easily can be implemented by parents and healthcare providers working together: Many children's hospitalizations might be avoided if parents and children were better educated about the child's condition, medications, the need for follow-up care, and the importance of avoiding known disease triggers."

Overall, says Dr. Flores, parents can take a more active role in this process by seeking to gain a thorough understanding of their child's condition, including optimal preventive and treatment measures. Parents need to ask their child's physician if they have questions about their child's illness.

"Know as much as you can about your child's condition," he advises, "including what triggers cause flare-ups, issues regarding medications, the importance of follow-up care, and how you can educate children so that they child can help themselves."

P. J. Early
HealthLink Contributing Writer

This article includes information from the US Centers for Disease Control and Prevention.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.