« Back

Asthma intervention initiated in urban ED may not impact follow-up care, asthma-related outcomes, study shows

Thursday, October 29 2009 | Comments

---

An intervention program based in the emergency department (ED) that includes asthma symptom screening, a mailed reminder and an educational video may improve beliefs of the importance of preventive care and beliefs about barriers to care but does not appear to improve primary care provider follow-up or other asthma-related outcomes, according to a recent study.

For the trial, families of 433 children aged 1 to 18 years who were discharged after receiving asthma treatment in an urban pediatric ED from March to December 2005 were randomized to receive the intervention or usual care. Those in the intervention group watched an educational video about asthma control that addressed beliefs and misconceptions about asthma care, received a letter to take to their primary care provider if they screened positive for persistent asthma symptoms and received a mailed reminder to follow-up with their primary care provider. The control group received standard discharge instructions to follow-up with their primary care provider within three to five days.

Asthma-related quality of life was evaluated using the Integrated Therapeutic Group Child Asthma Short Form and all study participants were surveyed about the benefits and barriers of follow-up care at the end of the ED visit. The primary study outcome measure was the rate of follow-up with a primary care provider during the four weeks after the ED visit. All study participants received telephone follow-up interviews one, three and six months after the ED visit.

Results showed that the intervention was well-accepted by families and impacted positive beliefs about the need for follow-up at the time of the ED visit. However, there was no significant difference between the intervention group and the control group with regard to the rates of primary care provider follow-up within one month after the ED visit (44.5 percent vs. 43.8 percent, respectively).

At the time of discharge from the ED, the intervention group participants were more likely to endorse positive beliefs about the benefits of follow-up care than the control group participants, but three months after the ED visit, there were no significant differences in the survey responses given by the two study groups. More participants in the intervention group (73 percent) than in the control group (65 percent) reported being extremely satisfied with the information received during the ED visit, yet this difference was not statistically significant.

The median time to follow-up with the primary care provider was 38 days in both groups. Subsequent ED visits, asthma-related quality of life and asthma symptoms were similar between the study groups.

In addition, daily controller medication use was highest during the four weeks after the ED visit, with 66 percent of intervention group participants and 64 percent of control group participants reporting daily use. These rates decreased at three and six months, but the differences between the groups were not significant at any time point.

"It is possible that intervention at a single visit is ineffective but cumulative reinforcement over time may have more benefits," the authors stated.

"Future research should evaluate interactive forms of education that can be implemented in the ED and combine education with initiation of preventive medications to assess impact on long-term outcomes," they concluded.

The data were published in the October issue of the journal Pediatrics.

Print  |  E-mail