Elsevier

The Journal of Pediatrics

Volume 145, Issue 6, December 2004, Pages 772-777
The Journal of Pediatrics

Original Article
Improving follow-up for children with asthma after an acute Emergency Department visit

https://doi.org/10.1016/j.jpeds.2004.08.029Get rights and content

Objective

To improve follow-up with primary care providers after acute Emergency Department (ED) asthma visits for children from low-income urban families.

Study design

A prospective, randomized, controlled trial evaluated combined telephone asthma coaching and monetary incentive. The primary outcome was asthma-planning visits with primary care providers within 15 days of index ED visits. The subjects were urban parents whose children were treated for asthma in the ED and had Medicaid or no insurance.

Results

We enrolled 527 parents (264 control and 263 intervention). There was a significant difference (P < .0001) between the intervention (35.7%) and control (18.9%) groups in the proportion of children who had asthma-planning visits and decreased mean nights/days with asthma symptoms by 4.36 intervention and 3.31 control at 2 weeks. The proportions of children with asthma-planning visits and acute asthma care visits during the 16-day to 6-month period were similar for both groups.

Conclusions

Telephone coaching and a monetary incentive significantly increased the proportion of low-income urban parents who brought their children for asthma-planning visits, and decreased asthma symptoms shortly after asthma ED visits. The intervention did not increase subsequent asthma-planning visits or decrease ED visits or hospitalizations.

Section snippets

Subjects

The subjects of this study were parents who brought their children to St. Louis Children's Hospital Emergency Department for treatment of an acute asthma exacerbation from February 1999 to May 2001. Inclusion criteria were parents of children 2 to 12 years of age, with Medicaid or no medical insurance. A child was considered to have asthma if the parent stated a physician had made the diagnosis. Exclusion criteria were (1) admission to hospital at the time of the ED visit, (2) chronic illness

Results

We enrolled 527 parents from February 1, 1999, to May 31, 2001: 264 in control and 263 in intervention groups (Figure 1). The groups were similar with regard to the child and parent characteristics (Table I). Chronic asthma symptoms were not significantly different between groups (Table I). The demographic characteristics of the children of parents who participated and who declined to participate were similar (Table II). The demographic characteristics were also similar between parents and

Discussion

The combination of two telephone coaching calls and monetary incentive significantly improved the frequency of asthma-planning visits after acute asthma ED visits for a group of low-income urban children. The coaching focused on communicating the need and importance of a PCP asthma-planning visit immediately after an acute exacerbation. Coaching provided the opportunity to reinforce recommendations made at the time of discharge from the ED and discuss benefits and possible barriers to making

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Cited by (90)

  • Management of Asthma Exacerbations in the Emergency Department

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    Citation Excerpt :

    Current evidence on the role of facilitated follow-up is somewhat conflicting. For example, 2 RCTs reported that facilitated referral of ED patients to the primary care providers did not change long-term asthma outcomes.129,131 In contrast, another RCT in an ED setting by Zeiger et al132 demonstrated that facilitated referral to an asthma specialist significantly reduced the risk of subsequent ED visits for asthma exacerbation.

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Supported by the National Institutes of Health: Heart, Lung, and Blood Institutes (HL 21512).

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