Benefits of subspecialty adherence after asthma hospitalization and patient perceived barriers to care

Izadi, Neema; Tam, Jonathan S.

doi:10.1016/j.anai.2017.02.024

Cited by 10 publications

(6 citation statements)

References 20 publications

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“…There was a significant difference in scheduled follow up in the pulmonary medicine consultation group compared to the no‐consultation group. Izadi et al 13 has previously shown that patients who have scheduled follow up with an asthma specialist before discharge as opposed to those who are merely referred are more likely to attend follow up. We were not able to reproduce this in our study as the difference in scheduled follow up did not translate to increased attendance of scheduled follow up.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary specialist involvement in critical asthma in the pediatric intensive care unit: A retrospective review

Paskaradevan

Zier

Rissmiller

et al. 2021

Pediatric Pulmonology

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Introduction Asthma is one of the most common chronic diseases of childhood. There is a scarcity of published literature on critical asthma, considered acute asthma requiring pediatric intensive care unit (PICU) admission. The goal of this study was to describe the clinical care of children with critical asthma admitted to a single center PICU and to determine whether pulmonary medicine consultation during admission impacted outcomes. Methods Retrospective chart review of known asthma patients aged 4–18 years admitted to a quaternary PICU between 01/2013 and 07/2019 for management of critical asthma. Results A total of 179 patients were enrolled with median age of 8 years. Median hospital length of stay (LOS) was 3.2 days and PICU LOS was 1.5 days. A total of 80 (44.7%) patients had a pulmonary medicine consultation. In the pulmonary medicine consultation group versus the no‐pulmonary medicine consultation group, there was a significant difference in hospital LOS (4.16 vs. 2.86 days, p value <.0001) and PICU LOS (2.00 vs. 1.00, p value <.0001), escalation of controller medication (66% vs. 21%, p value <.0001), scheduled outpatient pulmonology follow‐up (87.5% vs. 45.4%, p value <.0001), and receiving ≥3 courses of systemic steroids in the 12 months after discharge (32.2% vs. 14.7%). There was no difference in attendance of scheduled follow up appointments or in having ≥3 emergency room visits or admissions in the 12 months after discharge. Conclusion Pulmonary medicine consultation during hospital admission may impact management of critical asthma by increasing escalation of controller medication and scheduled outpatient follow up.

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Section: Discussionmentioning

confidence: 99%

Pulmonary specialist involvement in critical asthma in the pediatric intensive care unit: A retrospective review

Paskaradevan

Zier

Rissmiller

et al. 2021

Pediatric Pulmonology

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“…This is alarming as previous research has linked non-adherence with various adverse health outcomes such as increased emergency room utilization and hospitalizations. 6,7 Investments to identify and engage appropriate stakeholders to improve show rates, adherence, and patient experience will reduce future public health care expenditures.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…4 Furthermore, missed health supervision visits is associated with a variety of subsequent poor health outcomes, including increased health care costs, 5 emergency room visits, 6 and hospitalizations. 7 Physicians can find it challenging to manage pediatric health problems where social inequity may be contributing factor, and this is further complicated by the variable role of parents and social support services as caretakers and protectors. Trying to manage children with health problems can be complicated by missed surveillance or follow-up visits.…”

Section: Introductionmentioning

confidence: 99%

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Facilitators and Barriers to Access to Pediatric Medical Services in a Community Hospital

Shi

Castillo

Viswanathan

et al. 2020

J Prim Care Community Health

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Background: Missed medical appointments decrease continuity of medical care, waste resources, and may affect health outcomes. We examined the factors associated with missed children’s supervision visits in Eastern Brooklyn, NY, USA. Methods: We surveyed guardians whose children received routine medical care at four pediatric clinics. Participants filled out a questionnaire that queried: demographics, food security, recent relocation, parental support of healthy behaviors, and length of knowing provider. Preexisting disease(s) and missed visits were retrieved from medical records. Regression analyses were used to determine factors that were associated with missing medical appointments. Results: Among 213 families, 33% faced food insecurity and 16.4% reported moving within the past 12 months. Forty percent of children missed at least 1 visit. Food insecurity (adjusted odds ratio [aOR] 2.3, 95% confidence interval [CI 1.0% to 5.2%) and recent relocation (aOR 1.8, 95% CI 1.1-3.4 were associated with missed health supervision visits, whereas greater parental healthy behaviors (aOR 0.5, 95% CI 0.3-0.9) and longer length of knowing provider (aOR 0.8, 95% CI 0.7-1.0) were associated with fewer missed appointments. Conclusion: This study indicates that social inequity may contribute to poor adherence to medical appointments through multiple mechanisms, including food insecurity, lack of social stability, and parental health behaviors. Multidimensional proactive prevention, and reactive tolerance should be considered as opportunities to mitigate the impact of social inequity on health outcomes.

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“…5 Furthermore, nonadherence to health supervision visits is associated with a variety of subsequent poor health outcomes, including increased health care costs, 6 and hospitalizations. 7 The purposes of this study were the following: 1. To describe the differences between users and nonusers of the ER in terms of caregiver's social demographics, household food and relocation, child age and comorbidity, and adherence to health supervision.…”

Section: Introductionmentioning

confidence: 99%

Low Income and Nonadherence to Health Supervision Visits Predispose Children to More Emergency Room Utilization

Shi

Castillo

Viswanathan

et al. 2020

Global Pediatric Health

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Social inequity can have broad health impacts. The purpose of this study was to examine the effects of low income and nonadherence to health supervision visits on emergency room (ER) utilization in Eastern Brooklyn, New York. This study surveyed parents/guardians of children who received routine medical care at Brookdale ambulatory clinics from June 2017 to February 2018. Participants were asked to fill out a questionnaire on social demographics, food insecurity, and relocation. Electronic medical records (EMRs) were reviewed to retrieve numbers of missing health supervision and ER visit in past 12 months. Comorbidity was identified through EMR by International Classification of Diseases. Logistic regression analyses were used to examine the effects of nonadherence to health supervision visits on ER utilization when controlling for demographics, food insecurity, recent moving, and comorbidity. Among 268 participants, 56.0% reported their household income was less than $20,000 annually, 39.6% missed at least 1 health supervision visit, and 31.7% had at least 1 ER visit within the past 12 months. Younger age (adjusted odds ratio [aOR] = 0.92, 95% confidence interval [CI] = 0.86-0.97, P < .01), household income less than $20,000 (aOR = 1.86, 95% CI = 1.02-3.39), preexisting comorbidity (aOR = 2.36, 95% CI = 1.26-4.42), and nonadherence to health supervision visits (aOR = 5.83, 95% CI = 3.21-10.56) were associated with increased ER utilization. Nonadherence to health supervision visits is an independent risk factor and potentially modifiable. Evaluation and remediation should be pursued as a means of improving health outcomes of children in vulnerable circumstances.

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Benefits of subspecialty adherence after asthma hospitalization and patient perceived barriers to care

Cited by 10 publications

References 20 publications

Pulmonary specialist involvement in critical asthma in the pediatric intensive care unit: A retrospective review

Pulmonary specialist involvement in critical asthma in the pediatric intensive care unit: A retrospective review

Facilitators and Barriers to Access to Pediatric Medical Services in a Community Hospital

Low Income and Nonadherence to Health Supervision Visits Predispose Children to More Emergency Room Utilization

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