116: Canadian Pediatric Asthma Action Plans and Their Correlation with Current Consensus Guidelines
Bibliographic record
Abstract
While written action plans are standard in the treatment and management of asthma, variability exists in the content and format amongst plans. This variability results in inconsistent educational messages that lend themselves to patient confusion and decreased health outcomes. We aimed to assess the content of Canadian pediatric written action plans for consistency in format, layout, zone-defining symptoms, suggested treatment options, and adherence to current Canadian asthma care guidelines. Written action plans were sought from Canadian pediatric hospitals, teaching hospitals associated with academic centres, and from three national organizations, for a total of 17 plans. An analysis was carried out to assess the similarities and differences amongst the written action plans in relation to the study's objectives. Of all the Canadian pediatric written action plans, 76% were found to consist of three zones and 82% incorporated a traffic light-style design. The plans were divided between symptom-based (59%) and combined symptom- and peak-flow approaches (41%). The most common symptom descriptor in the green zone was “normal life/regular activities” (76%), in the yellow zone it was “cold/cold symptoms” (94%), and in the red zone it was “reliever medication does not work as usual” (53%). Considerable variability existed amongst written action plans and the symptom descriptors that define each zone. This variability was exemplified in the red zone where a total of twenty-four different symptom descriptors existed across the plans, but on average an individual plan contained only five symptom descriptors. Only 53% of asthma action plans mentioned asthma triggers within the plan. Greater consistency existed amongst the treatment strategies. However, the suggested treatment was often left to prescriber discretion as some plans included a blank text box to be filled by the health-care provider. In relation to the 2012 Canadian Thoracic Society guidelines, it was found that 59% of plans specified that inhaled corticosteroids should be taken daily, 47% of plans included a framework for an inhaled corticosteroid escalation strategy, and 41% of plans included oral corticosteroids as a treatment option. Canadian pediatric written action plans would be improved by nationally clarifying the symptom descriptors for each zone, the addition of asthma trigger information, increased emphasis on the common cold as a potential harbinger of worsening asthma symptoms, and further adoption of Canadian Thoracic Society guideline recommendations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.169 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.011 | 0.012 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".