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Graphic Medicine
at Work
Research Outcomes
When the Intervention
Is a Comic

Alex Thomas, MD
Gary Ashwal, MA
American Soci...
Disclosures
• This is an independent project whose pilot study is
funded by a grant from Friends of University of
Wisconsi...
Gary Ashwal, MA

Alex Thomas, MD
Background
•

36,000 children miss school
every day due to asthma

•

5 million people with asthma
are under age 18 (more ...
What can contribute to an
asthma exacerbation requiring
hospitalization?
1.
2.
3.
4.

Inherent severity of underlying dise...
Medication Adherence
• Rescue inhalers bring immediate relief to
asthma symptoms only offer temporary relief
(2 hours)
• M...
Education is Key
• Asthma education to promote self-management in children
has been shown to improve lung function, asthma...
Asthma Education
• Kathleen Shanovich, NP:
education specialist for
inpatient asthma
consults
o When not available,
educat...
When an education
specialist is not available
• Greater reliance on the available
educational materials
– Inconsistent in ...
Objective
Create appropriate content to teach kids:
1. Medication differences
2. Mechanisms of action

10
Rescue
Bronchodilator
Proventil
Albuterol

Controller
Corticosteroid
Qvar
Beclomethasone
Rescue
Bronchodilator

Controller
Corticosteroid

Pro Air

Flovent
Other blue one?

Rescue
Bronchodilator

Controller
Corticosteroid

Ventolin

Budesonide
Approach
• Kids can retain a great
depth of knowledge in
topics that interest them (i.e.
Skylanders, Pokemon,
Ben10, Super...
Anthropomorphized Medications

Controller
Inhaled Corticosteroid

Bronchodilator
Albuterol

© 1993, 1997, and 2009 by Alex...
Sequential Art

Pathophysiology
17
Sequential Art

Bronchodilator – Mechanism Of Action
18
Sequential Art

Corticosteroid – Mechanism Of Action
19
Story-driven Patient Education

Social Learning Theory – Modeling
20
Good vs. Evil

Hideout: basements, piles of leaves
Video Series

Comic Book

Video

22
Focus Group Testing
• 30 kids
• 2 clinics (1 suburban, 1 urban)
• Used feedback to make adjustments to
characters, visuals...
Madison Asthma Camp 2013
• 55 children (ages 8 – 15, mostly 1013)
– Higher risk group
– Predominantly minority population
...
Madison Asthma Camp 2013
Pre-Test

Post-Test

25
Madison Asthma Camp 2013
Pre-Test

Post-Test

26
Madison Asthma Camp 2013
Pre-Test

Post-Test

27
Madison Asthma Camp 2013
Pre-Test

Post-Test

28
Madison Asthma Camp 2013
Pre-Test

Post-Test

29
Madison Asthma Camp 2013
Pre-Test

Post-Test

30
Madison Asthma Camp 2013
Pre-Test

Post-Test

31
Madison Asthma Camp 2013
Pre-Test

Post-Test

32
Clinical Pilot
Study
UW Health Allergy Clinics

20 South Park Pediatrics

(160 patients/month)

(100 patients/month)

Amer...
Thank you!

Alex Thomas, MD
Gary Ashwal, MA
alex@boostershotcomics.com
gary@boostershotcomics.com
Twitter.com/boostershotc...
Iggy and The Inhalers - ASBH Presentation
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Iggy and The Inhalers - ASBH Presentation

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Booster Shot Comics presentation at The American Society for Bioethics and Humanities conference in Atlanta, October 2013.

Publié dans : Santé & Médecine
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Iggy and The Inhalers - ASBH Presentation

  1. 1. Graphic Medicine at Work Research Outcomes When the Intervention Is a Comic Alex Thomas, MD Gary Ashwal, MA American Society of Bioethics + Humanities Annual Meeting 2013
  2. 2. Disclosures • This is an independent project whose pilot study is funded by a grant from Friends of University of Wisconsin Hospital and Clinics • We have no other financial interests or relationships to disclose
  3. 3. Gary Ashwal, MA Alex Thomas, MD
  4. 4. Background • 36,000 children miss school every day due to asthma • 5 million people with asthma are under age 18 (more than 1 in 20 children) • Asthma is the third-ranking cause of hospitalization children • The estimated cost in the U.S. of treating asthma in those younger than 18 years of age is $3.2 billion per year. Portnoy J, Jennings D. Utilization patterns in an asthma intervention. Ann Allergy Asthma Immunol. 2006;97(Suppl 1):S25-S30.
  5. 5. What can contribute to an asthma exacerbation requiring hospitalization? 1. 2. 3. 4. Inherent severity of underlying disease Problems with medication use Exposure to environmental factors Deficits in education regarding asthma diagnosis and management EPR-3. Expert panel report 3: guidelines for the diagnosis and management of asthma (EPR-3 2007). NIH Publication Number 08-5846. Bethesda, MD: U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program; 2007.
  6. 6. Medication Adherence • Rescue inhalers bring immediate relief to asthma symptoms only offer temporary relief (2 hours) • More long lasting improvement and prevention of symptoms come with Controllers (must be taken daily) • Controller use in children with persistent asthma is low Adams RJ, Fuhlbrigge A, Finkelstein JA, Lozano P et al. Use of inhaled anti-inflammatory medication in children with asthma in managed care settings. Arch Pedatr Adolesc Med. 2001; 155 (4): 501-7 Finkelstein JA, Lozano P. Underuse of controller medications among medicaid-insured children with asthma. Arch Pedatr Adolesc Med. 2002; 156: 562-7
  7. 7. Education is Key • Asthma education to promote self-management in children has been shown to improve lung function, asthma symptoms, reduce health care utilization and school absenteeism • According to guidelines, asthma education programs should be delivered to children during or following discharge from the ED or the hospital Finkelstein JA, Lozano P. Underuse of controller medications among medicaid-insured children with asthma. Arch Pedatr Adolesc Med. 2002; 156: 562-7 EPR-3. Expert panel report 3: guidelines for the diagnosis and management of asthma (EPR-3 2007). NIH Publication Number 08-5846. Bethesda, MD: U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program; 2007.
  8. 8. Asthma Education • Kathleen Shanovich, NP: education specialist for inpatient asthma consults o When not available, education is provided by floor nurse coordinating discharge, RT Kathleen Shanovich, NP • But primary care clinics often do not have the time/staffing for individualized education
  9. 9. When an education specialist is not available • Greater reliance on the available educational materials – Inconsistent in quality – Inconsistent in how it is presented to kids • When one-on-one teaching is not available- with appropriate content, children can be challenged to play a more active role in the learning process
  10. 10. Objective Create appropriate content to teach kids: 1. Medication differences 2. Mechanisms of action 10
  11. 11. Rescue Bronchodilator Proventil Albuterol Controller Corticosteroid Qvar Beclomethasone
  12. 12. Rescue Bronchodilator Controller Corticosteroid Pro Air Flovent
  13. 13. Other blue one? Rescue Bronchodilator Controller Corticosteroid Ventolin Budesonide
  14. 14. Approach • Kids can retain a great depth of knowledge in topics that interest them (i.e. Skylanders, Pokemon, Ben10, Superheroes) • By anthropomorphizing medications into characters with personalities and physical traits directly related to their mechanism of action, understanding can be much more intuitive 15
  15. 15. Anthropomorphized Medications Controller Inhaled Corticosteroid Bronchodilator Albuterol © 1993, 1997, and 2009 by Alex Thomas; © 2013 Booster Shot Comics, Alex Thomas, Gary Ashwal 16
  16. 16. Sequential Art Pathophysiology 17
  17. 17. Sequential Art Bronchodilator – Mechanism Of Action 18
  18. 18. Sequential Art Corticosteroid – Mechanism Of Action 19
  19. 19. Story-driven Patient Education Social Learning Theory – Modeling 20
  20. 20. Good vs. Evil Hideout: basements, piles of leaves
  21. 21. Video Series Comic Book Video 22
  22. 22. Focus Group Testing • 30 kids • 2 clinics (1 suburban, 1 urban) • Used feedback to make adjustments to characters, visuals, text • Ideal age is 8-11yrs
  23. 23. Madison Asthma Camp 2013 • 55 children (ages 8 – 15, mostly 1013) – Higher risk group – Predominantly minority population • Asthma knowledge pretest in the morning • 30 minutes to read comic and view cards over lunch • Watched 12 minute video • Small group discussion with allergy fellow and school nurse • Asthma knowledge post test in the afternoon 24
  24. 24. Madison Asthma Camp 2013 Pre-Test Post-Test 25
  25. 25. Madison Asthma Camp 2013 Pre-Test Post-Test 26
  26. 26. Madison Asthma Camp 2013 Pre-Test Post-Test 27
  27. 27. Madison Asthma Camp 2013 Pre-Test Post-Test 28
  28. 28. Madison Asthma Camp 2013 Pre-Test Post-Test 29
  29. 29. Madison Asthma Camp 2013 Pre-Test Post-Test 30
  30. 30. Madison Asthma Camp 2013 Pre-Test Post-Test 31
  31. 31. Madison Asthma Camp 2013 Pre-Test Post-Test 32
  32. 32. Clinical Pilot Study UW Health Allergy Clinics 20 South Park Pediatrics (160 patients/month) (100 patients/month) American Family Children’s Hospital (10 patients/month) •Ages 6-13 years •Randomized Controlled Trial o Intervention: Iggy and the Inhalers Educational Program (comics, cards, video) o Control: current standard of care (nurse teaching if available, UW website handouts) •Outcome Measures o Knowledge of patients (age 8 and above) or parents (age 6-7)  pre and post-intervention knowledge testing  assessment of knowledge retention 2 weeks after intervention
  33. 33. Thank you! Alex Thomas, MD Gary Ashwal, MA alex@boostershotcomics.com gary@boostershotcomics.com Twitter.com/boostershotcmx facebook.com/boostershotcomics www.iggyandtheinhalers.com www.boostershotcomics.com

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