Predicting Emergency Department Utilization in Adults with Asthma: A Cohort Study

Cowie, Robert L.; Underwood, Margot; Revitt, Shirley G.; Field, Stephen K.

doi:10.1081/jas-100000037

Cited by 38 publications

(27 citation statements)

References 25 publications

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“…10 Predictors that are associated with increased risk of exacerbations in adults include being female, nonwhite, poor, a current smoker, or having had two or more ED visits or hospitalizations for asthma in the past year. [11][12][13][14] In children, predictors of being at risk for severe exacer- blocks of persistent symptoms was associated with the number of severe exacerbations using a x 2 test over 4 years. Next, we fi t a GEE model with persistent symptoms as the outcome and severe exacerbations as the predictor.…”

Section: Data Collectionmentioning

confidence: 99%

Predictors of Symptoms Are Different From Predictors of Severe Exacerbations From Asthma in Children

Tantisira

et al. 2011

Chest

120

114

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Section: Data Collectionmentioning

confidence: 99%

Predictors of Symptoms Are Different From Predictors of Severe Exacerbations From Asthma in Children

Tantisira

et al. 2011

Chest

120

114

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“…[27][28][29][30] Poorer quality of life (QoL) and perceived control of illness are also associated with greater health-care utilisation and increased ED attendances for asthma and chronic obstructive pulmonary disease (COPD). [31][32][33][34][35] The reasons for these associations are unclear. Psychological factors may influence people's decisions about when to use unscheduled care, or reduce their ability to cope in health emergencies, or may just be markers of greater morbidity.…”

Section: Introductionmentioning

confidence: 99%

CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

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BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…Asthma patients that depend on ED services are generally considered to have extremely poor disease control and a poor prognosis (4). It is important to identify characteristics related to poor disease control and frequent visits to the ED in order to apply appropriate clinical management (5).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with emergency department visits due to acute asthma

Dalcin

Piovesan

Kang

et al. 2004

Braz J Med Biol Res

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It is important to identify characteristics related to poor disease control and frequent visits to the emergency department (ED). The objective of the present study was to compare the characteristics of patients attending the adult ED for treatment of asthma exacerbation with those attending an asthma specialist clinic (AC) in the same hospital, and to determine the factors associated with frequent visits to the ED. We conducted a cross-sectional survey of consecutive patients (12 years and older) attending the ED (N = 86) and the AC (N = 86). Significantly more ED patients than AC patients reported ED visits in the past year (95.3 vs 48.8%; P < 0.001) and had difficulty performing work (81.4 vs 49.4%; P < 0.001. Significantly more AC than ED patents had been treated with inhaled corticosteroids (75.6 vs 18.6%; P < 0.001) used to increase or start steroid therapy when an attack was perceived (46.5 vs 20.9%; P < 0.001) and correctly used a metered-dose inhaler (50.0 vs 11.6%; P < 0.001). The history of hospital admissions (odds ratio, OR, 4.00) and use of inhaled corticosteroids (OR, 0.27) were associated with frequent visits to the ED. In conclusion, ED patients were more likely than AC patients to be dependent on the acute use of the ED, were significantly less knowledgeable about asthma management and were more likely to suffer more severe disease. ED patients should be considered an important target for asthma education. Facilitating the access to ambulatory care facilities might serve to reduce asthma morbidity.

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Predicting Emergency Department Utilization in Adults with Asthma: A Cohort Study

Cited by 38 publications

References 25 publications

Predictors of Symptoms Are Different From Predictors of Severe Exacerbations From Asthma in Children

Predictors of Symptoms Are Different From Predictors of Severe Exacerbations From Asthma in Children

CHOICE: Choosing Health Options In Chronic Care Emergencies

Factors associated with emergency department visits due to acute asthma

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