Factors associated with emergency department visits by children with asthma: implications for health education.

Wasilewski, Yvonne; Clark, Noreen M.; Evans, David; Levison, Moshe J.; Levin, Bruce; Mellins, Robert B.

doi:10.2105/ajph.86.10.1410

Cited by 95 publications

(67 citation statements)

References 17 publications

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“…The literature suggests that 25% of pediatric ED visits may be from chronic users of the ED. 9 However, for the purpose of this study, the number of patients that had repeat visits was less important than independent encounters. The paradigm for treatment by ED physicians currently presumes no continuity of care within that setting; thus, each encounter is approached and treated independently.…”

Section: Discussionmentioning

confidence: 93%

“…6,7 One recent study found that many parents of children with asthma could identify a primary care provider (PCP) but preferred to use the ED for asthma care because they perceived asthma as a disorder that should be treated as an emergency. 8 There is evidence that children with asthma present to the ED repeatedly 9 ; several published surveys suggest that at least 25% of such patients may be chronic users of the ED for primary asthma care, multiple acute episodes, or repeated visits during 1 exacerbation. 7,8 Overall, 30% of children treated for asthma in EDs require admission to the hospital.…”

Section: Methodmentioning

confidence: 99%

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The Effect of Acute and Chronic Asthma Severity on Pediatric Emergency Department Utilization

et al. 2006

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OBJECTIVE. Our goal was to teach emergency department (ED) physicians how to use standardized criteria for diagnosing and classifying asthma severity and to describe the patterns of pediatric ED utilization of these criteria for classification of both acute and chronic severity. METHOD.A health care provider education module was developed and implemented in 4 participating EDs in southeast Texas to educate ED physicians and health care providers on the diagnosis and acute and chronic severity classification of pediatric asthma patients. We undertook both retrospective (medical chart extraction) and prospective surveillance over a 2-year period of all children presenting to 1 of 4 EDs with acute asthma. Demographic characteristics, classification of severity, health care resource utilization, and primary physician contact information were collected.RESULTS. The health care provider educational intervention was provided for 84 different physicians. A subset of 16 physicians was randomly tested preintervention and postintervention. Mean mock-scenario scores at 2 weeks showed an improvement of 55.6%, which was sustained at retesting at 6 months. Over the 2-year period, 6222 individual pediatric ED encounters were entered into the surveillance database. The median age of presentation was 5 years. More than 32% of the patients in the study were uninsured. The majority of the patients in each category had asthma of mild severity: mild intermittent chronic (58.7%) and mild acute (53.9%).CONCLUSIONS. Physicians who completed a health care provider education module learned to effectively diagnose asthma and recognize standardized acute and chronic severity classifications. The majority of children with asthma who presented to the Texas Emergency Department Asthma Surveillance project's participating EDs were classified as having mild acute severity and mild intermittent chronic disease. Almost one third of these patients did not have health insurance.

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Section: Discussionmentioning

confidence: 93%

Section: Methodmentioning

confidence: 99%

The Effect of Acute and Chronic Asthma Severity on Pediatric Emergency Department Utilization

et al. 2006

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“…However, like most other studies, we found that a high proportion of these children exhibited health care-utilization patterns that suggest more severe or uncontrolled asthma; 25% had been hospitalized in the last year, and 60% had at least 1 prior ED visit for asthma in the last year. This apparent disconnect between the underlying asthma severity and the high rates of past ED visits and hospitalizations may be a reflection of the inability to accurately measure underlying asthma severity or the fact that health care-utilization patterns are driven in large part by behavioral and psychosocial factors 7,12 rather than disease-specific measures such as asthma severity and control. Another interesting and paradoxical finding with respect to the high frequency of past ED use in this population was that only 5% reported that the ED was their usual source of asthma care.…”

Section: Discussionmentioning

confidence: 99%

“…2 ED use for asthma care in children has been associated with many factors including younger age, gender, minority status, poverty, living in an urban area, having Medicaid or lack of insurance, access to care, quality of care, allergen-prone environments, and poorer health. [6][7][8][9][10][11][12] However, the vast majority of these studies have been conducted in the inner-city environments of very large urban centers. There is less known about whether the characteristics of children who visit EDs in more suburban and rural settings differ from those of their urban counterparts.…”

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confidence: 99%

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

et al. 2006

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OBJECTIVES. Asthma is one of the more common reasons for children's visits to the emergency departments (EDs). Many studies show that the level of asthma care and self-management in children before an ED visit for asthma is often inadequate; however, most of these studies have been conducted in the inner cities of large urban areas. Our objectives were to describe asthma care and management in children treated for asthma in 3 EDs located in an urban, suburban, or rural setting.METHODS. We studied a prospective patient cohort consisting of children aged 2 to 17 years who presented with an acute asthma exacerbation at 3 EDs in western Michigan. An in-person questionnaire was administered to the parent or guardian during the ED visit. Information was collected on demographics; asthma history; usual asthma care; frequency of symptoms during the last 4 weeks; current asthma treatment, management, and control; and past emergency asthma care. A telephone interview conducted 2 weeks after the ED visit obtained follow-up information. The 8 quality indicators of asthma care and management were defined based on recommendations from national guidelines.RESULTS. Of 197 children, 70% were enrolled at the urban site, 18% at the suburban site, and 12% at the rural site. The average age was 7.9 years; 60% were male, and 33% were black. At presentation, nearly half (46%) of the children had mild intermittent asthma, 20% had mild persistent asthma, 15% had moderate persistent asthma, and 19% had severe persistent asthma. One quarter of the children had been hospitalized for asthma, and two thirds had at least 1 previous ED visit in the past year. At least 94% had health insurance coverage and 95% reported having a primary care provider.Less than half of the children had attended at least 2 scheduled asthma appointments with their regular asthma care provider in the past year. Although only 5% of the subjects reported that the ED was their only source of asthma care, at least 30% reported that they always went directly to the ED when they needed urgent asthma care. Only 3 in 5 children possessed either a spacer or a peak-flow meter, whereas ϳ2 in 5 reported having a written asthma action plan. Among those with persistent asthma, there was considerable evidence of undertreatment, with 36% not on either an inhaled corticosteroid or a suitable long-term control medication. Only 20% completed a visit with their regular asthma care provider within 1 week of their ED visit. Despite very high levels of health care coverage and access to primary care, the overall quality of asthma care and management fell well short of that recommended by national guidelines.A STHMA IS ONE of the more common reasons for children's visits to emergency departments (EDs). 1-3 National health surveys and utilization rates of hospital services for asthma treatment indicate that the burden of asthma in US children has increased dramatically in the past 2 decades. 4,5 The number of ED visits for asthma in children Յ14 years of age increased ϳ14% in the Un...

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“…5,6,15 Wasilewski et al 15 observaram que crianças com hospitalização prévia por asma apresentavam alto risco de utilizar serviços de emergência. Sua conclusão foi que famílias usando freqüentemente serviços de emergência necessitam de educação sobre asma.…”

Section: Discussionunclassified

Fatores de risco para consultas em pronto-socorro por crianças asmáticas no Sul do Brasil

et al. 2000

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OBJETIVOS: Traçar um perfil das crianças asmáticas do município de Pelotas, RS, conhecer o manejo da doença e os fatores de risco associados a consultas em pronto-socorro, motivadas por asma. MÉTODOS: Estudo transversal aninhado a um estudo de coorte, realizado na área urbana de Pelotas, cidade de médio porte do Sul do Brasil. Participaram 981 crianças de 4-5 anos, pertencentes à coorte de 1993. RESULTADOS: A prevalência de asma encontrada na amostra estudada foi de 25,4%. A morbidade por asma foi elevada: 31% das crianças asmáticas haviam procurado o pronto-socorro no último ano, 57% tinham consultado médico e 26%, de 1 a 4 anos, foram internadas por asma. Na análise geral, escolaridade e renda familiar baixas associaram-se com consultas em pronto-socorro (RO=4,1 para 0 a 4 anos de escolaridade e RO=6,5 para menos de 1 salário-mínimo). Dormir em quartos com 3 ou mais pessoas também mostrou-se associado (RO=2,2), bem como severidade das crises (RO=2,7), uso de medicamentos para asma no último ano (RO=1,9) e internações por asma (RO=3,0). CONCLUSÕES: A prevalência de asma entre crianças pré-escolares em Pelotas é alta, levando a grande morbidade. Encontraram-se como fatores preditores de consultas em pronto-socorro por asma, após análise multivariada, a baixa escolaridade das mães, severidade das crises e internação por asma.

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Factors associated with emergency department visits by children with asthma: implications for health education.

Cited by 95 publications

References 17 publications

The Effect of Acute and Chronic Asthma Severity on Pediatric Emergency Department Utilization

The Effect of Acute and Chronic Asthma Severity on Pediatric Emergency Department Utilization

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

Fatores de risco para consultas em pronto-socorro por crianças asmáticas no Sul do Brasil

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