Matrix as an Educational Approach to Asthma
Matrix as an Educational Approach to Asthma
Health care providers agree that asthma care must be individualized to fit the need of the child and family. A written plan in the form of a matrix enables the health care provider to give families a step-by-step individualized plan of care for asthma. This article discusses the use of a long-term treatment plan in matrix form as an educational tool for health care providers and for families. The written long-term plan can be used to guide treatment for any level of asthma severity. Following a review of asthma pathogenesis and diagnosis, categories of medications are presented, along with their role in a long-term treatment plan. The National Heart, Lung, and Blood Institute guidelines are used as a basis for the recommendations in the long-term treatment plan.
A paradox exists regarding asthma. Although we now have a better understanding of the pathophysiology of asthma than ever before, along with access to better medications for asthma treatment, we are seeing an increased incidence of asthma, an increase in hospitalizations because of asthma, and higher rates of asthma morbidity and mortality.
The treatment of asthma has been approached by way of medical and developmental models. Many resources, such as an educational booklet by Plaut (1991), an algorithm by Rachelefsky (1995), and a developmental model by Ladebauche (1997), provide suggestions for ways to simplify asthma treatment. However, the outcomes continue to be less than favorable, and asthma mortality continues to grow, especially among minorities and inner-city populations. Asthma is the most common chronic illness of childhood, with a prevalence rate of 6.9% (4.8 million children) in the United States (Centers for Disease Control and Prevention [CDC], 1996). The prevalence is even higher in minority populations. From 1980 to 1994, asthma has increased by 160% in children younger than 5 years (Yunginger et al., 1992). From 1979 to 1995, asthma deaths more than doubled in children 0 to 14 years of age (CDC, 1998).
Geller (1996) suggests that the increase in mortality from asthma is related to the failure of patients, parents, and health care providers to recognize the severity of asthma; delayed or inadequate treatment; and excessive reliance on
2-agonists. Other possible causes include insufficient dosing or improper administration of medication.
A long-term treatment plan in matrix form (Mellins, Evans, Clark, Zimmerman, & Wiesemann, 2000) was formulated to provide step-by-step guidelines in asthma care as baseline symptoms move between mild and severe or even when new symptoms existfor example, the earliest sign of a respiratory infection, a known trigger for exacerbations. The health care provider will discover throughout this article that the matrix provides predictability. It saves time and is practical for practitioner and family use. The matrix incorporates recommendations based on guidelines produced by the expert panel of the National Asthma Education and Prevention Program Coordinating Committee and published by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institute of Health (NHLBI, 1997).
The goals of the treatment plan are to control asthma by reducing inflammation and bronchoconstriction. The goal or purpose of the matrix form is to facilitate the implementation of the therapeutic plan by promoting self-regulation (Clark & Zimmerman, 1990).
Health care providers agree that asthma care must be individualized to fit the need of the child and family. A written plan in the form of a matrix enables the health care provider to give families a step-by-step individualized plan of care for asthma. This article discusses the use of a long-term treatment plan in matrix form as an educational tool for health care providers and for families. The written long-term plan can be used to guide treatment for any level of asthma severity. Following a review of asthma pathogenesis and diagnosis, categories of medications are presented, along with their role in a long-term treatment plan. The National Heart, Lung, and Blood Institute guidelines are used as a basis for the recommendations in the long-term treatment plan.
A paradox exists regarding asthma. Although we now have a better understanding of the pathophysiology of asthma than ever before, along with access to better medications for asthma treatment, we are seeing an increased incidence of asthma, an increase in hospitalizations because of asthma, and higher rates of asthma morbidity and mortality.
The treatment of asthma has been approached by way of medical and developmental models. Many resources, such as an educational booklet by Plaut (1991), an algorithm by Rachelefsky (1995), and a developmental model by Ladebauche (1997), provide suggestions for ways to simplify asthma treatment. However, the outcomes continue to be less than favorable, and asthma mortality continues to grow, especially among minorities and inner-city populations. Asthma is the most common chronic illness of childhood, with a prevalence rate of 6.9% (4.8 million children) in the United States (Centers for Disease Control and Prevention [CDC], 1996). The prevalence is even higher in minority populations. From 1980 to 1994, asthma has increased by 160% in children younger than 5 years (Yunginger et al., 1992). From 1979 to 1995, asthma deaths more than doubled in children 0 to 14 years of age (CDC, 1998).
Geller (1996) suggests that the increase in mortality from asthma is related to the failure of patients, parents, and health care providers to recognize the severity of asthma; delayed or inadequate treatment; and excessive reliance on
2-agonists. Other possible causes include insufficient dosing or improper administration of medication.
A long-term treatment plan in matrix form (Mellins, Evans, Clark, Zimmerman, & Wiesemann, 2000) was formulated to provide step-by-step guidelines in asthma care as baseline symptoms move between mild and severe or even when new symptoms existfor example, the earliest sign of a respiratory infection, a known trigger for exacerbations. The health care provider will discover throughout this article that the matrix provides predictability. It saves time and is practical for practitioner and family use. The matrix incorporates recommendations based on guidelines produced by the expert panel of the National Asthma Education and Prevention Program Coordinating Committee and published by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institute of Health (NHLBI, 1997).
The goals of the treatment plan are to control asthma by reducing inflammation and bronchoconstriction. The goal or purpose of the matrix form is to facilitate the implementation of the therapeutic plan by promoting self-regulation (Clark & Zimmerman, 1990).
