Effects of Increased Primary Care Access on Process of Care and Health Outcomes Among Patients With Asthma Who Frequent Emergency Departments

Am J Med. 2004 Oct 1;117(7):479-83. doi: 10.1016/j.amjmed.2004.04.011.

Abstract

Purpose: Many asthmatic patients discharged from emergency departments do not have timely follow-up visits with a primary care physician. This study was conducted to determine the effectiveness of a health professional-based intervention in improving process of care and health outcomes among asthmatic patients discharged from emergency departments.

Methods: We enrolled 125 asthmatic patients, aged 5 through 50 years, from the emergency department of a community-based hospital; 62 patients were assigned to usual care and 63 to enhanced care. Enhanced care consisted of usual care plus employment of a coordinator to make follow-up appointments with the patient's primary care physician with at least one reminder telephone call to the patient.

Results: At 6 months of follow-up, mean (+/- SD) asthma and pediatric quality-of-life scores were higher in the enhanced care group than in the usual care group (5.7 +/- 1.2 units vs. 5.0 +/- 1.3 units, P = 0.01). The enhanced care group also had a higher rate of follow-up office visits (78% [n = 44] vs. 60% [n = 33], P = 0.003), were more likely to have written action plans (46% [n = 26] vs. 25% [n = 14], P = 0.02), and had fewer asthma symptoms (1.8 +/- 1.1 units vs. 2.2 +/- 1.3 units, P = 0.09). However, these differences disappeared by 12 months of follow-up.

Conclusion: A simple intervention wherein a health professional facilitates follow-up visits can improve the process of care and health outcomes of high-risk asthmatic patients. However, the effect of this intervention is time limited and largely wears off by 12 months.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aftercare / standards*
  • Alberta
  • Asthma / psychology
  • Asthma / therapy*
  • Child
  • Child, Preschool
  • Emergency Service, Hospital / standards*
  • Female
  • Follow-Up Studies
  • Health Services Accessibility / standards*
  • Health Services Research
  • Health Status
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care*
  • Primary Health Care / standards*
  • Program Evaluation
  • Quality of Life
  • Reminder Systems / standards
  • Severity of Illness Index
  • Total Quality Management / organization & administration