{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T03:07:42Z","timestamp":1780715262358,"version":"3.54.1"},"reference-count":15,"publisher":"Springer Publishing Company","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Doct Nurs Pract"],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold>The prevalence of childhood asthma in the United States is 6.5%. During the COVID-19 pandemic, a Federally Qualified Health Center (FQHC) implemented metered-dose inhalers (MDIs) with spacers instead of nebulized albuterol to reduce aerosolization of pathogens and reduce costs.<jats:bold>Objective:<\/jats:bold>The objective of the study is to assess the safety, efficacy, and efficiency of a change to the asthma exacerbation protocol at an urban FQHC.<jats:bold>Methods:<\/jats:bold>A retrospective chart review compared nebulized albuterol versus an MDI with a spacer in pediatric patients experiencing asthma exacerbation. The evaluation aimed to measure (a) the 30-day return to care in either the emergency department (ED) or clinic, (b) the total number of treatments administered, and (c) the documented use of an oral steroid with albuterol treatments.<jats:bold>Results:<\/jats:bold>Return to clinic was the only statistically significant variable. Zero MDI patients returned, whereas 61% of those nebulized returned within 30 days (<jats:italic>p<\/jats:italic>&lt; .00001).<jats:bold>Conclusions:<\/jats:bold>Albuterol MDI with a spacer was more effective than a nebulizer in reducing follow-up visits to the clinic and was effective at reducing ED visits within 30 days.<jats:bold>Implications for Nursing:<\/jats:bold>Treating asthma exacerbations in the primary care clinic with an MDI is effective and reduces cost and airborne exposure.<\/jats:p>","DOI":"10.1891\/jdnp-2023-0059","type":"journal-article","created":{"date-parts":[[2024,8,16]],"date-time":"2024-08-16T18:45:20Z","timestamp":1723833920000},"page":"157-162","source":"Crossref","is-referenced-by-count":2,"title":["Metered-Dose Inhaler Versus Nebulizer Treatment for Acute Asthma Exacerbation: A Process Evaluation"],"prefix":"10.1891","volume":"17","author":[{"given":"Christopher","family":"Graybill","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"Paramesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Gray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Bosak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"793","published-online":{"date-parts":[[2024,8,16]]},"reference":[{"key":"2024111307500689000_17.3.157.1","unstructured":"Bonatch, M . (2021). What is a Federally Qualified Health Center (FQHC)? https:\/\/www.carecloud.com\/continuum\/federally-qualified-health-center\/"},{"key":"2024111307500689000_17.3.157.2","first-page":"179","article-title":"Cost variation and revisit rate for adult patients with asthma presenting to the emergency department","year":"2022","journal-title":"The American Journal of Emergency Medicine"},{"key":"2024111307500689000_17.3.157.3","unstructured":"Center for Disease Control and Prevention. (2023). Most recent national asthma data. U.S. Department of Health & Human Services . https:\/\/www.cdc.gov\/asthma\/most_recent_national_asthma_data.htm"},{"key":"2024111307500689000_17.3.157.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.10.003"},{"key":"2024111307500689000_17.3.157.5","first-page":"133","article-title":"Socioeconomic determinants of pediatric asthma emergency department visits under regional economic development in western New York","year":"2019","journal-title":"Social Science & Medicine"},{"key":"2024111307500689000_17.3.157.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2016.06.054"},{"issue":"3","key":"2024111307500689000_17.3.157.7","first-page":"e103","article-title":"Asthma in children: A brief review for primary care providers","year":"2019","journal-title":"Pediatric Annals"},{"key":"2024111307500689000_17.3.157.8","unstructured":"HRSA. (2022). 340B drug pricing program. HRSA . https:\/\/www.hrsa.gov\/opa"},{"issue":"1","key":"2024111307500689000_17.3.157.9","article-title":"Classification of aerosol-generating procedures: A rapid systematic review","year":"2020","journal-title":"BMJ Open Respiratory Research"},{"issue":"4","key":"2024111307500689000_17.3.157.10","first-page":"1129","article-title":"The outcomes and acceptance of pressurized metered\u2010dose inhaler bronchodilators with venturi mask modified spacer in the outpatient emergency department during the COVID\u201019 pandemic","year":"2021","journal-title":"Journal of Clinical Pharmacy and Therapeutics"},{"issue":"12","key":"2024111307500689000_17.3.157.11","first-page":"3268","article-title":"Metered-dose Inhalers versus nebulization for the delivery of albuterol for acute exacerbations of wheezing or asthma in children: A systematic review with meta-analysis","year":"2020","journal-title":"Pediatric Pulmonology"},{"key":"2024111307500689000_17.3.157.12","first-page":"89","article-title":"Trends in treatment costs of U.S. emergency department visits","year":"2022","journal-title":"The American Journal of Emergency Medicine"},{"issue":"1","key":"2024111307500689000_17.3.157.13","first-page":"55","article-title":"Increasing metered dose inhaler use for acute asthma exacerbations in the pediatric emergency department: A quality improvement challenge","year":"2018","journal-title":"Clinical Pediatric Emergency Medicine"},{"issue":"5","key":"2024111307500689000_17.3.157.14","first-page":"948","article-title":"Variables associated with emergency department utilization by pediatric patients with asthma in a federally qualified health center","year":"2019","journal-title":"Journal of Community Health"},{"issue":"1","key":"2024111307500689000_17.3.157.15","first-page":"12","article-title":"Patient safety from the perspective of quality management frameworks: A review","year":"2021","journal-title":"Patient Safety in Surgery"}],"container-title":["Journal of Doctoral Nursing Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1891\/JDNP-2023-0059","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T16:31:25Z","timestamp":1731515485000},"score":1,"resource":{"primary":{"URL":"http:\/\/connect.springerpub.com\/lookup\/doi\/10.1891\/JDNP-2023-0059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,16]]},"references-count":15,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,11,13]]},"published-print":{"date-parts":[[2024,11,1]]}},"alternative-id":["10.1891\/JDNP-2023-0059"],"URL":"https:\/\/doi.org\/10.1891\/jdnp-2023-0059","relation":{},"ISSN":["2380-9418","2380-9426"],"issn-type":[{"value":"2380-9418","type":"print"},{"value":"2380-9426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,16]]}}}