Published online September 5, 2006
PEDIATRICS Vol. 118 Supplement August 2006, pp. S36 (doi:10.1542/peds.2006-0900HHH)
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Predictors of Primary Care Follow-up After a Pediatric Emergency Visit for Asthma

Harvey L. Leo, MD

Ann Arbor, MI

ABSTRACT

PURPOSE OF THE STUDY.: To identify predictors associated with primary care pediatrician (PCP) follow-up in children evaluated for acute asthma in a pediatric emergency department (ED).

STUDY POPULATION.: Parents of children aged 2 to 18 years being discharged after asthma treatment in a pediatric ED.

METHODS.: Parents were surveyed by coordinators and described their child’s asthma history and perceived benefits and barriers to making a PCP follow-up visit. Bivariate tests and multivariable logistic regression were used to determine association with completion of a follow-up visit within 4 weeks of the ED visit.

RESULTS.: A total of 278 subjects (n = 278) were enrolled; 55% saw their PCP within 4 weeks of the ED visit. Baseline factors that were associated with an increased likelihood of follow-up included a recent hospitalization, >1 ED visit for asthma in the past year, the parent’s assessment that the child had "very severe" asthma, and current daily use of a controller medication. Parental beliefs that taking daily asthma medications and finding out about the causes of asthma attacks were also associated with increased PCP follow-up rate. Parents were less likely to follow-up if they reported a lack of convenient appointments or prolonged waits in the PCP office. A multivariable model including clinical factors, parental beliefs, and the study intervention predicted the likelihood of follow-up.

CONCLUSIONS.: Parental beliefs about asthma severity, the benefits of controlling asthma, and organizational barriers to seeing a PCP were associated with follow-up after a pediatric ED visit for asthma.

REVIEWER COMMENTS.: Many children receive their first and subsequent follow-up visits for acute asthma attacks in the ED. Unfortunately, this is an inefficient and cost-prohibitive method of managing asthma. This study attempted to identify parental perceptions of their child’s disease and the barriers to proper follow-up. These issues are paramount for the pediatrician caring for these children. Addressing parental concerns and removing barriers to follow-up can improve asthma control and allow for more cost-effective management and proper utilization of health care resources. Both the acute treating physician and practicing pediatrician can influence the possibility of appropriate follow-up and care.

Zorc JJ, Scarfone RJ, Li Y. J Asthma. 2005;42:571–576[CrossRef][ISI][Medline]