Cartography of Emergency Department Visits for Asthma – Targeting High‐Morbidity Populations

Lajoie, Pierre; Laberge, A; Lebel, Germain; Boulet, Louis‐Philippe; Demers, Marie-France; Mercier, Pierre; Gagnon, Mona-Josée

doi:10.1155/2004/607625

Cited by 17 publications

(13 citation statements)

References 25 publications

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“…The institutions were selected primarily because of a high number of visits to their ED for acute asthma, as shown by the Quebec Provincial Health Program (Ré gie de l'Assurance Maladie-RAMQ) database and validated by a recent "cartography" of asthma-related morbidity in the province of Quebec. 17 …”

Section: Selection Criteria For Participating Institutionsmentioning

confidence: 99%

Evaluation of a Program Aimed at Increasing Referrals for Asthma Education of Patients Consulting at the Emergency Department for Acute Asthma

Robichaud

Laberge

Allen

et al. 2004

Chest

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Section: Selection Criteria For Participating Institutionsmentioning

confidence: 99%

Evaluation of a Program Aimed at Increasing Referrals for Asthma Education of Patients Consulting at the Emergency Department for Acute Asthma

Robichaud

Laberge

Allen

et al. 2004

Chest

Self Cite

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“…The physicians were recruited from 10 regions in the province of Quebec with access to an AEC; these regions were identified as having high asthma-related morbidity according to recently published asthma care gaps (18). Targeted AECs had to meet the accreditation requirements of the QACN and educate a minimum of 50 asthma patients each year.…”

Section: Study Populationmentioning

confidence: 99%

Can Access to Spirometry in Asthma Education Centres Influence the Referral Rate by Primary Physicians for Education?

Labrecque

Lavallee²,

Beauchesne³

et al. 2006

Canadian Respiratory Journal

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M Labrecque, M Lavallée, MF Beauchesne, A Cartier, LP Boulet. Can access to spirometry in asthma education centres influence the referral rate by primary physicians for education? Can Respir J 2006;13(8):427-431.BACKGROUND AND OBJECTIVES: Asthma remains uncontrolled in a large number of asthmatic patients. Recent surveys have shown that a minority of asthmatic patients are referred to asthma educators.The objective of the present study was to assess the influence of increased access to spirometry in asthma education centres (AECs) on the rate of patient referrals to these centres by general practitioners. METHODS: A one-year, prospective, randomized, multicentric, parallel group study was conducted over two consecutive periods of six months each, with added spirometry being offered in the second sixmonth period to the experimental group. Ten AECs were enrolled in the project. An advertisement describing the AECs' services was sent by mail to a total of 303 general practitioners at the start of each period, inviting them to refer their patients. Measures of the frequency of medical referrals to the AECs were assessed for each period. RESULTS: The group of AECs randomly selected for spirometry in the second six-month period received 48 medical referrals during the first period and 32 during the second one, following proposed spirometry. AECs that had not offered spirometry received five referrals during the first period and seven during the second period. One AEC withdrew a few weeks after the study began and others encountered administrative problems, reducing their ability to provide interventions. CONCLUSIONS: Referral to AECs is not yet integrated into the primary care of asthma and offering more rapid access to spirometry in the AECs does not seem to be a significant incentive for such referrals.

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“…1,2 Variations between and within provinces in rates of hospital admissions and ED visits for asthma in children and in adults [3][4][5][6] have been documented. These variations raise concerns regarding the quality of and access to asthma care in communities and EDs.…”

Section: Introductionmentioning

confidence: 99%

Multicentre evaluation of an emergency department asthma care pathway for adults

Lougheed

Olajos-Clow

Szpiro

et al. 2009

CJEM

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Objective: We sought to determine whether a standardized emergency department (ED) asthma care pathway (ACP) for adults would be accepted by ED staff, improve adherence to Canadian ED asthma management guidelines and improve patient outcomes. Methods: Ten Ontario hospital EDs (5 intervention, 5 control) participated in a 5-month pre-post intervention study. Emergency department management, admissions, repeat ED visits and ED length of stay were compared between sites and by ACP use versus nonuse at intervention sites. Results: The ACP was used in 101 of 383 visits (26.4%) at 5 intervention sites. Use of the ACP varied significantly between sites, ranging from 6% to 60% (p < 0.001). When compared with control sites, there were significant increases in the use of metered dose inhalers (MDIs), inhaled steroids, referrals, documentation of teaching, patient recollection of teaching (all with a p < 0.001) and oxygen (p = 0.001). Use of peak expiratory flow rate (PEFR) measurements decreased in both intervention and control sites. Increased PEFR documentation and systemic steroid use in the ED and on discharge were only found in patients who were on the ACP at intervention sites. Admissions increased from 3.9% to 9.4% at intervention sites in contrast to control sites, where they remained fairly stable (p = 0.016), but did not differ by ACP use. The length of stay for discharged patients increased by a mean of 16 minutes for ACP patients at intervention sites (p = 0.002). There were no statistically significant differences in repeat ED visits. Conclusion: Adoption of a standardized ED ACP for adults is highly variable. Despite modest uptake, which averaged 26%, beneficial changes in specific aspects of asthma care delivery were found, notably in referrals and recollection of teaching done during the ED visit, without a substantial increase in ED length of stay. These changes may lead to improvements in outcomes, such as reduced relapse rates, which this study was not designed or powered to detect. Provincial and national implementation strategies that address barriers to clinical pathway adoption are warranted and have the potential to improve adherence to guidelines and outcomes for asthma patients. RÉSUMÉObjectif : Nous avons voulu vérifier si un plan clinique standardisé pour le traitement de l'asthme chez l'adulte serait accepté par le personnel des urgences et s'il allait promouvoir l'observance des lignes directrices canadiennes pour la prise en charge de l'asthme aux urgences et améliorer le pronostic des patients. Méthode : Dix services d'urgence d'hôpitaux en Ontario (5 appliquant l'intervention et 5 témoins) ont participé à cette étude pré-et post-intervention d'une durée de 5 mois. Nous avons comparé la prise en charge, les admissions, les visites multiples et la durée du séjour aux urgences entre les différents services, selon qu'ils appliquaient ou non le plan clinique. Résultats : Cinq services d'urgence assignés au groupe appliquant l'intervention ont effectivement utilisé le plan clinique lors de 101 c...

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Cartography of Emergency Department Visits for Asthma – Targeting High‐Morbidity Populations

Cited by 17 publications

References 25 publications

Evaluation of a Program Aimed at Increasing Referrals for Asthma Education of Patients Consulting at the Emergency Department for Acute Asthma

Evaluation of a Program Aimed at Increasing Referrals for Asthma Education of Patients Consulting at the Emergency Department for Acute Asthma

Can Access to Spirometry in Asthma Education Centres Influence the Referral Rate by Primary Physicians for Education?

Multicentre evaluation of an emergency department asthma care pathway for adults

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