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Biomedical subjects

John R Meurer

Publications and source records attributed to John R Meurer.

17 recordsLinked to original sources
PubMed2006

Genetic aspects of the etiology and treatment of asthma.

This article provides a clinical review of the genetic aspects of the etiology and treatment of asthma for pediatric practitioners who are experienced in asthma diagnosis and management but lack expertise in genetics and immunology. Asthma is caused by the interaction of genetic susceptibility with environmental factors. The asthmatic response is characterized by elevated production of IgE, cytokines, and chemokines; mucus hypersecretion; airway obstruction; eosinophilia; and enhanced airway hyperreactivity to spasmogens. The genes most clearly associated with asthma include disintegrin and metalloprotease ADAM-33, dipeptidyl peptidase 10, PHD finger protein 11, and the prostanoid DP1 receptor. Within a few years, practitioners may apply sophisticated knowledge of cell and molecular biology to expand pharmacotherapeutic approaches and to personalize diagnosis and management.

Asthma↗
PubMed2006

Engaging health care providers in coalition activities.

Health care providers play a key role in promoting and participating in asthma coalition activities. Barriers to participation include lack of time, concern about coalition effectiveness, and unfamiliarity with community-based approaches to health issues. Despite this, the Allies Against Asthma coalitions were successful at involving health care providers in leadership roles, on advisory committees, and as research and clinical experts. Successful engagement strategies included presentation of data illustrating need for improved asthma care, identification of clinicians who were involved in caring for children with uncontrolled asthma, and education regarding the added value of a coalition and benefits of participation. Despite barriers to participation, health care providers felt that their participation in asthma coalitions helped them to develop collaborative relationships with other agencies, increase their professional knowledge and skills with regard to asthma management, and improve access to priority populations.

Asthma↗
PubMed2006

Childhood asthma surveillance by community coalitions.

Multiple benefits can accrue when community coalitions conduct asthma surveillance activities. Surveillance data are used to identify children with asthma, assess disease burden and needs in the community, understand the illness and risk factors, identify children with asthma who are undertreated, plan community interventions, evaluate the effect of interventions, and monitor trends. These data, which are used to inform coalition and program decisions and to evaluate asthma interventions, can also be used to strengthen state and national asthma surveillance efforts and to inform clinical practice and public health policies. Local coalition data collection represents a complementary approach to national asthma surveillance, allowing action at the local level and showing how local findings vary from national observations. The Allies Against Asthma coalitions developed several practical means to conduct childhood asthma surveillance that informed coalition efforts and facilitated innovative linkages among government officials, health care providers, community agencies, families, and academicians and/or researchers.

Adolescent↗
PubMed2006

The coalition process at work: Building care coordination models to control chronic disease.

Asthma is a highly prevalent and frequently misunderstood chronic disease with significant morbidity. Integrating client services at the patient-centered level and using coalitions to build coordinated, linked systems to affect care may improve outcomes. All seven Allies Against Asthma coalitions identified inefficient, inconsistent, and/or fragmented care as issues for their communities. In response, the coalitions employed a collaborative process to identify and address problems related to system fragmentation and to improve coordination of care. Each coalition developed a variety of interventions related to its specific needs and assets, stakeholders, stage of coalition formation, and the dynamic structure of its community. Despite common barriers in forming alliances with busy providers and their staff, organizing administrative structures among interinstitutional cultures, enhancing patient and/or family involvement, interacting with multiple insurers, and contending with health system inertia, the coalitions demonstrated the ability to produce coordinated improvements to existing systems of care.

Asthma↗
PubMed2006

From formation to action: How allies against asthma coalitions are getting the job done.

Coalitions develop in and recycle through stages. At each stage (formation, implementation, maintenance, and institutionalization), certain factors enhance coalition function, accomplishment of tasks, and progression to the next stage. The Allies Against Asthma coalitions assessed stages of development through annual member surveys, key informant interviews of 16 leaders from each site, and other evaluation tools. Results indicate all coalitions completed formation and implementation, six achieved maintenance, and five are in the institutionalization stage. Differences among coalitions can be attributed to their maturity and experience working within a coalition framework. Participants agreed that community mobilization around asthma would not have happened without coalitions. They attributed success to being responsive to community needs and developing comprehensive strategies, and they believed that partners' goals were more innovative and achievable than any institution could have created alone.

Asthma↗
PubMed2006

Improving quality of care and promoting health care system change: The role of community-based coalitions.

As part of their community action plans, the Allies Against Asthma coalitions have developed efforts to improve quality of care and promote health care system change. All the coalitions have used an interdisciplinary collaborative approach to design these strategies and demonstrated a range of intervention approaches appropriate to their local context and circumstances. The coalitions' collective experience suggests that coalitions provide three key forces for quality improvement and change that may be lacking in the current fragmented U.S. health care system--motivation to change the status quo, integration across systems, and accountability for results. The collaborative and empowering processes that a coalition model encourages and the direct advocacy opportunity provided to the consumer appear to bring these forces into play.

Asthma↗
PubMed2006

Emergency department allies: a controlled trial of two emergency department-based follow-up interventions to improve asthma outcomes in children.

OBJECTIVE: We sought to study the impact of emergency department (ED)-based intensive primary care linkage and initiation of asthma case management on long-term, patient-oriented outcomes for children with an asthma exacerbation. METHODS: Our study was a randomized, 3-arm, parallel-group, single-blind clinical trial. Children aged 2 through 17 years treated in a pediatric ED for acute asthma were randomly assigned to standard care (group 1), including patient education, a written care plan, and instructions to follow up with the primary care provider within 7 days, or 1 of 2 interventions. Group 2 received standard care plus assistance with scheduling follow-up, while group 3 received the above interventions, plus enrollment in a case management program. OUTCOMES: The primary outcome was the proportion of children having an ED visit for asthma within 6 months. Other outcomes included change in quality-of-life score and controller-medication use. RESULTS: Three hundred fifty-two children were enrolled; 78% completed follow-up, 69% were black, and 70% had persistent asthma. Of the children, 37.8% had a subsequent ED visit for asthma, with no difference among the treatment groups (group 1: 38.4%; group 2, 39.2%; group 3, 35.8%). Children in all groups had a substantial, but similar, increase in their quality-of-life score. Controller-medication use increased from 69.4% to 81.4%, with no difference among the groups. CONCLUSION: ED-based attempts to improve primary care linkage or initiate case management are no more effective than our standard ED care in improving subsequent asthma outcomes over a 6-month period.

Adolescent↗
PubMed2005

Adolescent hospital discharges associated with self-poisonings in Wisconsin, 2000-2002.

OBJECTIVE: This study investigates the Wisconsin adolescent self-poisoning problem, using state discharge data on medication-related self-inflicted injuries, focusing on medications used and risk factors. METHODS: Wisconsin inpatient discharge files for 3 years (January 1, 2000-December 31, 2002) were evaluated. Medication-related injuries were analyzed for intentionality, medications used, discharge status, and risk factors such as mental illness, eating disorders, and alcohol abuse or dependence. RESULTS: There were nearly 3000 medication-related injury hospitalizations--1150 of them self-poisoning hospitalizations--among Wisconsin 12-17 year olds during 2000-2002. Females 12-17 years had twice as many medication-related injuries as males. Sixty percent of medication-related injuries occurred in patients with a mental disorder diagnosis. Non-narcotic analgesics were most commonly used and had one of the highest rates of intentionality (65%). A large proportion of intentional/suicidal medication-related injuries were discharged to another facility (35%), compared to 14% among all medical injuries. Males with medication-related injuries were twice (95% CI: 1.60, 2.75) as likely and females 1.4 (95% CI: 1.2, 1.6) times as likely to have intentional/suicidal injuries if they also abused or depended on alcohol. CONCLUSIONS: Given that a nonfatal suicide attempt is the strongest predictor of eventual suicide, the hundreds of self-poisoning discharges per year in Wisconsin 12-17 year olds is a serious public health concern. Both the medical community and public health community should heed the warnings of these nonfatal suicide attempts and implement educational programs addressing this issue.

Adolescent↗
PubMed2004

Voluntary progress toward universal newborn hearing screening.

OBJECTIVES: This study assessed the prevalence of newborn hearing screening in Wisconsin between 1997 and 2001, and examined factors leading to establishment of programs and influencing the outcomes of universal newborn hearing screening (UNHS). The primary goal was to identify characteristics that might be important for states, provinces or countries that have not yet implemented UNHS programs and to examine some unique components of the Wisconsin UNHS program, that may provide direction to areas both with and without programs. METHODS: The study consisted of two cross-sectional surveys administered at two separate time points (2000 and 2001). Additional data was provided by the Wisconsin Sound Beginnings Early Detection and Hearing Intervention database. RESULTS: Between 1997 and 2001, the number of Wisconsin birthing hospitals with UNHS programs increased from two to 92 of a total of 103 and the percent of all Wisconsin newborns screened for hearing loss before 1-month of age increased from 10 to 90%. In 2001, 2.6% of screened newborns had an abnormal test requiring further audiologic evaluation, with a higher rate of referral in programs relying only on otoacoustic emission testing versus automatic auditory brainstem testing. As programs were being established, hospitals with greater number of deliveries more readily developed UNHS programs and hospitals with more deliveries were also significantly more likely to screen a greater percentage of delivered children once their programs were established. The Wisconsin Sound Beginnings program established a screening program for home birth infants in 2002 with a current screen rate of 79% for those midwives participating in this program. CONCLUSIONS: A vast majority of Wisconsin hospitals have voluntarily implemented UNHS programs. By 2001, greater than 90% of all Wisconsin newborns were screened through a UNHS program. With education, financial support and a statewide network dedicated to UNHS it is possible to establish programs even for infants born in a setting that should be considered high-risk to miss hearing screening, such as home births and hospitals that perform relatively few numbers of deliveries per year. UNHS programs need to develop coordinated systems for linking these programs to audiologic diagnostic services and early intervention programs.

Cross-Sectional Studies↗
PubMed2004

Pediatric asthma case management: a review of evidence and an experimental study design.

Asthma is a complex disease that involves physiological, environmental, and psychosocial factors. This paper reviews childhood asthma case management by social service professionals, lay health workers, and nurses, and it presents a new randomized controlled study using nurse case management in a local community coalition. Evidence suggests the common factor for success involves case managers spending time contacting and patiently and persistently working with the family, thus building a trusting relationship. Although case management time is an expense for a health care payer, provider, and the child and family, the positive outcomes achieved can demonstrate the benefit of these interventions to all parties involved. The described experimental study assesses the cost and effectiveness of home-based nurse case management by a community coalition for children visiting an emergency department for asthma care.

Asthma↗
PubMed2004

Factors associated with physician interventions to address adolescent smoking.

OBJECTIVE: To determine the percent of adolescent Medicaid patients with medical record documentation about tobacco use status and cessation assistance; and factors associated with providers documenting and intervening with adolescent smokers. DATA SOURCE: Secondary analysis of data collected in 1999 from medical records of Wisconsin Medicaid health maintenance organization (HMO) recipients 11 to 21 years old. STUDY DESIGN: Random reviews and data collection were related to visits from January 1997 to January 1999. Data collected included patient demographics, provider type, number of visits, and whether smoking status and cessation interventions were documented. DATA EXTRACTION METHODS: Medical charts were reviewed and a database was created using a data abstraction tool developed and approved by a committee to address tobacco use in Medicaid managed care participants. PRINCIPAL FINDINGS: Among adolescents seen by a physician from 1997 to 1999, tobacco use status was documented in 55 percent of patient charts. Most often tobacco use status was documented on history and physical or prenatal forms. Of identified adolescent smokers, 50 percent were advised to quit, 42 percent assisted, and 16 percent followed for smoking cessation. Pregnant patients were more likely to have tobacco use documented than nonpregnant patients (OR=10.8, 95 percent CI=4.9 to 24). The odds of documentation increased 21 percent for every one-year increase in patient age. CONCLUSIONS: Providers miss opportunities to intervene with adolescents who may be using tobacco. Medical record prompts, similar to the tobacco use question on prenatal forms and the tobacco use vital sign stamp, are essential for reminding providers to consistently document and address tobacco use among adolescents.

Adolescent↗
PubMed2004

Association between infant continuity of care and pediatric emergency department utilization.

OBJECTIVE: The objective of this study was to examine the association between continuity of care (COC) and emergency department (ED) utilization during infancy, when the bonds between a provider and a family are first forming and health care utilization is at it highest levels. METHODS: A retrospective birth cohort was conducted of children who were born between December 1, 1999, and April 30, 2000; health care use during the first 25 months of life was analyzed. A COC score was calculated from well-child visits in the first 7 months of life. Subsequent ED utilization, for both a 12-month and an 18-month period, was evaluated through 2 measures: 1) ED reliance (the fraction of all visits that occurred in the ED) and 2) number of ED visits. Spearman rank correlation coefficients (r(s)) between COC and ED utilization were calculated. Partial rank correlations were calculated controlling for Medicaid status, income, gender, and the total number of health care visits. RESULTS: A total of 181 children were included in the study; 96 (53%) were male, and 48 (27%) were covered by Medicaid. COC scores ranged from 0 to 1, with a median of 1. COC scores were negatively correlated with both ED reliance (r(s) = -.214) and number of ED visits (r(s) = -.215) with 12 months of follow-up. The negative correlation was even stronger at 18 months of follow-up (ED reliance: r(s) = -.247; number of ED visits: r(s) = -.242), and this relationship remained significant with partial rank correlations. CONCLUSIONS: Improved COC in infancy is associated with a decrease in subsequent ED utilization. Interventions aimed at increasing the continuity of early well-child visits may decrease ED utilization.

Cohort Studies↗
PubMed2004

Efforts to quit smoking by parents of children with asthma.

The objective of this project was to assess the prevalence of (1) tobacco smoke exposure at home among children with asthma and (2) efforts to quit smoking by their parents. We employed a cross sectional survey of 622 parents of children diagnosed by a doctor with asthma. Seventy-five percent of parents reported smoke-free homes. Overall, 85% of parents pledged to keep smoke-free homes, 92% in existing smoke-free homes and 64% in homes with smoke.

Adult↗
PubMed2002

Parental perceptions of well-child care visits in an inner-city clinic.

OBJECTIVES: To assess parental perceptions of the importance of well-child care (WCC) in an inner-city clinic and to determine what type and format of information parents would like to obtain at WCC visits. METHODS: A convenience sample of parents accompanying a child aged 12 years or younger attending an inner-city pediatric teaching clinic completed self-administered written surveys. Parents ranked the importance of WCC overall, as well as its various components, using Likert scales. Parents also responded to checklist-style questions to indicate selected topics they would like to receive more information about and the format of information they preferred (written, talking to the physician, or videotapes in the waiting room). RESULTS: A total of 239 parents completed surveys. Overall they believed WCC was important (91% responded "extremely important" or "very important"). The individual WCC components ranked most important by parents were immunizations, growth and development issues, and the opportunity to discuss behavior or other concerns. The topics of information requested most frequently were how to help their child learn healthy eating habits (55%), how to help their child do well in school (53%), and how to keep their child safe outside of their home (49%). Written information was the format most frequently preferred (65%) by parents for receiving information. CONCLUSIONS: Parents of inner-city children consider WCC important. They want to hear about child health-related issues and prefer a written format. This knowledge can guide health care providers and educators during WCC visits and while teaching.

Ambulatory Care Facilities↗
PubMedDate not supplied

Guiding mothers' management of health problems of very low birth-weight infants.

OBJECTIVE: Explore the feasibility, usefulness, and outcomes of a pilot program to support mothers in developing competencies for managing health problems of their very low birth-weight (VLBW) infants in partnership with the primary care clinician (PCC). DESIGN: In a randomized study, mothers who received guided participation (GP) and printed guidelines for managing VLBW infant health problems were compared with mothers who received only the guidelines and standard care (GL group). SAMPLE: All mothers (GP = 20; GL = 11) were at least 18 years old and English speaking. Infants were all VLBW (< or =1,500 g). INTERVENTION: GP began during the infant's neonatal intensive care unit stay and continued with public health nurses (PHNs) and a family service clinician through the infant's first 4 postterm months. MEASUREMENTS: Intervention feasibility and usefulness were assessed with maternal and clinician feedback. Outcomes included maternal and clinician appraisal of mothers' use of clinical resources and mothers' perceptions of primary-care quality and the family-PCC relationship. RESULTS: Intervention feasibility and usefulness were supported. GP and GL groups did not differ significantly on outcomes. CONCLUSIONS: Findings indicate a longer intervention period, GP organized by infant problem episodes, and enhancement of the PHN role in the context of interdisciplinary and interagency collaboration.

Attitude of Health Personnel↗
PubMedDate not supplied

Coding for asthma patient education in the primary care setting.

Counseling and education for chronic diseases is a common service provided by primary care physicians. By not using and understanding the basic concepts in documentation and coding, primary care providers deny themselves proper reimbursement for the quality care they provide. Although we have used asthma as an example, concepts discussed here can be applied to other chronic diseases that require patient self-management. We review coding strategies that should be used when counseling and education are the main focus of the patient visit. We review additional procedures and techniques to make office flow, documentation, and coding proceed more smoothly.

Asthma↗