Sin DD, Bell NR, Svenson LW, Man SF. Am J Med. 2002;112:120–125
Purpose of the Study.
The purpose of this study was to examine the relation between follow-up office visits after emergency discharge and the risk of emergency readmissions in patients with asthma or chronic obstructive pulmonary disease (COPD).
Study Population and Methods.
We used population-based data to identify all patients in Alberta, Canada, who had at least 1 emergency visit for asthma or COPD between April 1, 1996, and March 31, 1997 (N = 25 256). A Cox proportional hazards model was used to estimate the adjusted relative risk (RR) of a repeat visit to an emergency department (ED) within 90 days of an initial emergency visit in patients who did or did not have an office follow-up within the first 30 days.
There were 7829 patients (31%) who had an office visit during the 30 days after their initial emergency encounter. Follow-up visits were associated with a significant reduction in the 90-day risk of an emergency readmission (RR: 0.79; 95% confidence interval [CI]: 0.73–0.86). Sensitivity analyses showed that a follow-up visit was inversely associated with a repeat emergency visit after adjusting for age, sex, area of residence, and income.
Although these data should be interpreted with caution because of missing information on factors such as quality of care, they suggest that follow-up office visits are effective in reducing early relapses in patients who have been recently treated in EDs for asthma or COPD.
These results come as no surprise to those of us in office practices. I try to have telephone contact within 24 hours and an office visit within 72 hours for asthmatics treated in an ED for an attack of asthma. Unfortunately, in this country too many patients don’t have an office to follow-up with (which is why they used the ED in the first place).