PURPOSE OF THE STUDY.
To describe the follow-up care for asthmatic patients within 28 days of an emergency department (ED) visit and its association with ED revisits and hospital admissions in the subsequent year.
In this study, 29 391 children with asthma between the ages of 2 and 17 treated in an ED in Ontario, Canada, between April 16, 2006, and February 28, 2009, had their chart reviewed in a population-based retrospective cohort study. Multiple linked health administrative data sets available through the Institute for Clinical Evaluative Sciences were used to gather data.
Data were collected by using the National Ambulatory Care Reporting System, Canadian Institute for Health Information Discharge Abstract Database, and Ontario Health Insurance Plan claims database to identify ED visits, hospital admissions, and outpatient visits, respectively. Only children with preexisting asthma were chosen for the study. The primary and secondary outcomes were the number of children having an ED visit and those having a hospital admission for asthma within 29 to 365 days, respectively. Statistical analysis was done by using SAS (SAS Institute, Inc, Cary, NC) for UNIX.
Of the 29 391 children, 32.8% had a follow-up, 22.1% had an ED revisit, and 2.7% had a hospital admission. Having a follow-up visit was not found to be associated with ED revisit or hospitalizations (hazard ratio, 0.98; 95% confidence interval, 0.93–1.03 and hazard ratio, 1.06; 95% confidence interval, 0.92–1.23, respectively). Younger children, those who were in the lower income quintile, and those with more severe acute or chronic asthmatics at the time of ED visits were more likely to have ED revisits and hospitalizations. Other characteristics such as number of visits and type of physician providing care were not associated with outcomes.
Follow-up care was not accessed after an ED visit for asthmatic patients even in a universal health care setting. Those that did have follow-up had no association with reduced ED revisits and hospitalizations in the subsequent year.
This study highlights the discrepancy between the factors we usually think are associated with good follow-up care for asthmatic patients presenting to the ED and what actually happens. Even with universal health care and accessibility, poor follow-up outcomes can still occur, thus it is important to work toward identifying other factors that have a greater impact on follow-up, ED revisits, and hospitalizations. Ultimately identifying these factors can help us to better manage and control our asthmatic patients.
- Copyright © 2013 by the American Academy of Pediatrics