Effects of increased primary care access on process of care and health outcomes among patients with asthma who frequent emergency departments

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Purpose

Many asthmatic patients discharged from emergency departments do not have timely follow-up visits with a primary care physician. This study was conducted to determine the effectiveness of a health professional–based intervention in improving process of care and health outcomes among asthmatic patients discharged from emergency departments.

Methods

We enrolled 125 asthmatic patients, aged 5 through 50 years, from the emergency department of a community-based hospital; 62 patients were assigned to usual care and 63 to enhanced care. Enhanced care consisted of usual care plus employment of a coordinator to make follow-up appointments with the patient's primary care physician with at least one reminder telephone call to the patient.

Results

At 6 months of follow-up, mean (± SD) asthma and pediatric quality-of-life scores were higher in the enhanced care group than in the usual care group (5.7 ± 1.2 units vs. 5.0 ± 1.3 units, P = 0.01). The enhanced care group also had a higher rate of follow-up office visits (78% [n = 44] vs. 60% [n = 33], P = 0.003), were more likely to have written action plans (46% [n = 26] vs. 25% [n = 14], P = 0.02), and had fewer asthma symptoms (1.8 ± 1.1 units vs. 2.2 ± 1.3 units, P = 0.09). However, these differences disappeared by 12 months of follow-up.

Conclusion

A simple intervention wherein a health professional facilitates follow-up visits can improve the process of care and health outcomes of high-risk asthmatic patients. However, the effect of this intervention is time limited and largely wears off by 12 months.

Section snippets

Patients and setting

This study was conducted at the Misericordia Hospital in Edmonton, Alberta, Canada, between April 2001 and November 2002. All patients between the ages of 5 and 50 years who were admitted to the emergency department with a primary diagnosis of asthma were eligible for participation. The study was approved by the Health Research Ethics Board (Biomedical Panel), Faculty of Medicine and Dentistry, University of Alberta.

The study comprised an enhanced care and usual care arm. To best mimic a

Results

During the study period, 250 patients were evaluated for asthma in the emergency department. Of these, 125 were excluded for the following reasons: 63 (24%) could not be reached to obtain informed consent, 43 (17%) did not wish to participate, and 19 (7%) declined for other reasons, including inability to comprehend English or lack of a fixed address. In total, 125 patients were enrolled in the study (Table 1): 112 (90%) completed 6 months of follow-up and 103 (82%) completed the full 1-year

Discussion

This community-based study produced several interesting observations. Our findings suggest that a simple health professional–based intervention can increase the rates of follow-up visits by asthmatic patients to their primary care physicians after emergency discharge. The increase in the frequency of these follow-up visits was associated with a statistically significant and clinically meaningful improvement in disease-specific health-related quality of life (10). These patients who were

Acknowledgment

The authors thank Lynda Haug and Arnold Vanderveen for their invaluable contributions as study coordinators; the staff at the Misericordia Hospital emergency department, who made it possible to implement this study at this site; and Cliff Seville and his staff, who provided office space and support services for this project.

References (14)

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This work was supported in part by the Medical Services Budget Innovation Fund from the Alberta Medical Association, Edmonton, Alberta, Canada. Dr. Sin is supported by a Canada Research Chair (Obstructive Airways Disease) and a GSK/St. Paul's Hospital Foundation COPD Professorship.

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