Browsing by Author "Allsopp, Leslie"
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Item Policy Focused Implementation Mapping to Advance Equity and Best Practice in School Asthma Services(2024-03-21) Manohar, Ishaan; Roth, Hannah; Allsopp, LesliePurpose: The goal of Dissemination and Implementation (D&I) science is to reduce the gap between best practices and those services widely implemented; D&I is key to improving health outcomes and equity. Pediatric asthma services exemplify the critical need for D&I, but application to advance best practices has been limited. Despite the availability of effective treatment, the CDC estimates that 44% of children with current asthma are poorly managed with entrenched disparities in adverse outcomes. Comprehensive school asthma programs with stocked quick-relief medication are shown to be effective. However, only 2% of Texas school districts have policies to permit this intervention. Further, before 2023, Texas legislation regarding stock albuterol was at sharp variance to national recommendations. In 2023, state-wide collaboration in Texas resulted in amendments that align policy with published recommendations. Asthma 411 is a model to advance comprehensive best practices in school asthma services including stock albuterol. It is currently adopted by 350 schools in North Central Texas. Implementation mapping is a multi-step process with systematic strategies to advance each stage of D&I. Producing implementation protocols and tools is a key element of the 5th step of the process. Policy-focused implementation mapping brings these approaches to legislative initiatives to maximize public health benefits and advance equity. The purpose of this study is to initiate policy implementation mapping for the guideline-based, Texas legislation passed in 2023 focusing on protocols and tools for implementation of the Asthma 411 model. Methods: Newly passed Texas legislation (SB 294 88R) was outlined and included categories of implementation mandates along with the specific requirements within each category. Each existing Asthma 411 implementation tool was independently assessed by two researchers and matched to corresponding legislative requirements. The researchers then identified mandates and guidelines that were not matched to any existing tool. Existing Asthma 411 tools that were matched to the new requirements, were also independently reviewed by two researchers to determine whether it was in alignment with policy or required modification. Discrepancies in researcher assessment were resolved by consensus review. New tools or modifications of existing tools were then drafted to create a preliminary, full suite of tools to support Task 4 of the implementation mapping process. Results: Researchers identified eight relevant categories within the new legislation. Nine existing tools were identified that require modification to align with new legislation and associated guidelines. Five new requirements in the new policy were identified that lack a tool or protocol to support the implementation of the new policy. Draft modifications and new implementation tools have been constructed. Conclusion: The resulting set of preliminary tools are uploaded to the Asthma 411 website where they are free and available for download. Free, online, on-demand professional development modules are being constructed for the use of these tools. Evaluation is ongoing. This work exemplifies the application of policy-focused implementation mapping to produce tools that support state-level best practices to improve asthma outcomes and advance equity. The process developed may be applied to the implementation of other school health policies.Item A Rapid Systematic Literature Review: Barriers to Health Services in Pediatric Refugee Populations(2024-03-21) Abbas, Hibah; Hudson, Megan; Spitzer, Lillian; Allsopp, LesliePurpose: Pediatric refugee populations in the United States have lower rates of immunization, difficulty accessing health care, decreased access to health insurance, and lower preventative visit attendance. This systematic review seeks to analyze the existing literature on health services for refugee children in the United States and to understand the socio-demographic, cultural, and systemic factors that contribute to these challenges. Two research questions were investigated: 1) what barriers are identified in the literature to the provision of adequate healthcare among refugee children in the United States, 2) does evidence suggest there are existing services and solutions that are accessible to refugee communities? Methods: A systematic search of electronic databases, including PubMed, CINAHL, and SCOPUS, was conducted to identify relevant peer-reviewed articles published. PRISMA guidelines for rapid reviews were followed, keywords were defined, and Covidence was used to structure content. The initial search produced 547 studies, and after 34 duplicates were removed, 513 studies remained. Title and abstracts were screened based on inclusion criteria, specifically, studies published in the last 10 years that referenced health services for pediatric refugee populations. Studies were excluded based on incorrect participant age and population specifications. Editorials and non-peer-reviewed articles were also excluded. 79 articles received a full-text review, with 13 articles meeting all inclusion criteria. These articles (n=13) were analyzed, content related to the research questions was classified using a data extraction tool, and common themes and patterns were identified. Results: Nine common themes isolated among the articles were linguistic differences, trauma-related mental health issues, lack of insurance coverage, cultural differences, limited health literacy, transportation difficulties, stigma, social isolation, and insufficient housing. The most prevalent theme isolated was linguistic differences with 11 out of the 13 studies that met inclusion criteria including it as a barrier to accessing healthcare. While these are listed as distinct themes and patterns, it is important to note that many of these barriers are interrelated. Our review revealed a lack of coherent and consistent services designed to meet the complex needs of this high-risk population. Conclusion: This rapid systematic review highlights the need for targeted interventions and policies that address the complex and interrelated barriers refugee populations face in accessing health care services. There does not appear to be consistent services that target this population specifically. In prior studies, refugee children were shown to have lower rate of immunizations, emphasizing the need for improved vaccination outreach strategies and health education. The isolated nine barriers serve as a foundational starting point to build targeted interventions to better serve this vulnerable population. Since linguistic differences were the most prevalent barrier to care, targeted interventions should include translators, either in-person or virtual, to be made available at clinics to provide care to this population. Ultimately, a more comprehensive understanding of these barriers through further research and policy development can improve health equity and outcomes for pediatric refugee populations in the United States.Item Unassigned Albuterol: A Rapid Review of School-Based Stock Inhaler Programs and Asthma Outcomes(2024-03-21) Loux, Paige; Khoei, Amenda; Allsopp, LeslieBackground: Asthma affects over 6 million children in the US and poorly managed asthma is a leading cause of school absenteeism. An estimated60% of children with current asthma have at least one attack each year. Guidelines recommend that quick-relief medication (albuterol)always be available to those with asthma, but it is estimated only20% of children with reported asthma have their own medication at school. As a result, it’s estimated over 3 million US children with current asthma attend school each day without timely access to quick-relief medication. To address this problem, schools may “stock” albuterol and administer this medication for episodes of respiratory distress using standing delegation orders. Timely administration of albuterol may potentially prevent asthma episodes from escalating and may be lifesaving. While stock albuterol is not new, implementation has been slow and peer-reviewed literature has been limited until recently. The purpose of this study is to assess the current evidence base regarding stock albuterol by conducting a rapid systematic literature review focused on three research questions: (Q1) What is currently known about the impacts of unassigned albuterol on asthma outcomes? (Q2) What outcome categories have been reported in the existing literature? (Q3) What barriers to implementation have been identified? Methods: We conducted a rapid review using PRISMA guidelines and Covidence software. PubMed, SCOPUS, and CINAHL databases were included. Inclusion and exclusion criteria were established, and a data extraction tool developed. The search was expanded to include grey literature with a focus on conference proceedings using Google Scholar. Results: Our initial search yielded 262 articles. After removing 164 duplicates and screening titles and abstracts,31articles were included in the final review. (Q1) Eleven articles reported on short term outcomes, including disposition of students after stock albuterol was used, EMS calls, and asthma associated absences. No articles evaluated the impact of stock albuterol policies on asthma control or measures of intermediate to long term asthma outcomes. (Q2) Current research has also included the following topics: barriers to implementation, legislation, nursing satisfaction, the role of unlicensed assistive personnel, and the relationship of stock albuterol to social determinants of health and disparities. Among these, implementation barriers were most frequent, being included in 21 of the 31 articles. Four articles addressed disparities. (Q3) Among the 21 articles addressing implementation barriers, the most frequently reported were perceived liability risk, funding, obtaining prescriptions, and delays between policy change and program implementation. Conclusions: The review reveals consistent, positive short-term outcomes following the use of stock albuterol and benefits including reduced EMS and potential decreases in absences. General barriers to implementation have been well-defined. The review also suggests several areas where the existing evidence base is thin or lacking. This includes impacts of policy implementation on asthma control and intermediate to long term outcomes, disparities, and inclusion of context specific barriers and facilitators of implementation.