Asthma
Conditions
Keywords
asthma, emergency department, compliance, randomized clinical trial
Brief summary
Little is known about how ED-based programs can help to reduce pediatric ED visits for asthma. The current study evaluated a novel intervention in which the ED itself became the site of highly individualized, comprehensive follow-up asthma care. It sought to determine if such an intervention could decrease subsequent unscheduled visits for asthma while improving asthma quality of life.
Detailed description
Prospective, randomized clinical trial of a single visit to a specialized emergency department-based asthma follow-up clinic occurring 2-15 days after emergency department care for an acute exacerbation. All patients were followed for 6 months. Analysis was by intention-to-treat with adjustment for baseline differences. Our primary hypothesis was that this intervention would decrease subsequent unscheduled visits (both to EDs and other sources of urgent care) for asthma over a six-month follow-up period. We further hypothesized that the intervention would decrease hospitalizations for asthma, improve compliance with an individualized medical plan and with trigger control, increase scheduled primary care practitioner (PCP) visits for routine asthma care, and decrease asthma symptoms while improving asthma quality of life (QOL).
Interventions
BEHAVIORALEmergency Department based asthma follow-up clinic
The clinical activities of the intervention followed a fully specified protocol and provided education and care in three domains: 1. Asthma self-monitoring and management: Educators first reviewed the basic physiology of asthma with emphasis on its chronicity. After evaluating asthma severity and treatment history, the physician completed an individualized medical action plan (MAP) and provided any necessary device teaching. 2. Environmental modification and trigger control: After evaluation of potential environmental triggers in the home, each family was educated on their control. Each child was provided hypoallergenic bed encasings. 3. Linkages and referrals to ongoing primary care: Clinic staff stressed the importance of longitudinal asthma care by a PCP. A full report of the clinic visit was mailed to each child's PCP. In addition, the asthma educator scheduled a follow-up appointment with the PCP within 4 weeks
Sponsors
American Academy of Allergy, Asthma, and Immunology
Robert Wood Johnson Foundation
Stephen J. Teach, MD, MPH
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
12 Months to 17 Years
Healthy volunteers
No
Inclusion criteria
1. age between 12 months and 17 years, inclusive; 2. prior physician-diagnosed asthma; 3. ≥1 other unscheduled visit for asthma in the previous 6 months and/or ≥1 hospitalization for asthma in the prior 12 months; 4. a parent/guardian available for interview; 5. residence in Washington, DC or a contiguous Maryland county; and 6. requirement for ≥3 doses of nebulized albuterol in the ED at the time of enrollment.
Exclusion criteria
1. significant medical co-morbidities affecting the cardiorespiratory system; 2. a visit to an allergist or a pulmonologist in the prior 6 months; 3. ≥2 of the following: a current written asthma medical action plan, current use of \>1 controller medication, or a scheduled visit for asthma care with their PCP in the prior two weeks; 4. enrollment in another asthma research study; 5. unavailability for telephone follow-up; or 6. primary language other than English or Spanish.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Unscheduled visits for asthma | 6 months following enrollment |
Secondary
| Measure | Time frame |
|---|---|
| Hospitalizations for asthma | 6 months following enrollment |
| Compliance | 6 months following enrollment |
| Quality of Life | 6 months following enrollment |
| Morbidity | 6 months following enrollment |
Countries
United States
Outcome results
None listed