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