Primary care visits for asthma monitoring over time and association with acute asthma visits for urban Medicaid-insured children

Abstract

Objectives To examine the association between numbers of primary care provider (PCP) visits for asthma monitoring (AM) over time and acute asthma visits in the emergency department (ED) and at the PCP for Medicaid-insured children. Methods We prospectively enrolled children 2–10 years-old during ED asthma visits. We audited hospital and PCP records for each subject for 3 consecutive years. We excluded subjects also receiving care from asthma subspecialists. PCP AM visits were those with documentation that suggested discussion of asthma management but no acute asthma symptoms or findings. PCP “Acute Asthma” visits were those with documentation of acute asthma symptoms or findings, regardless of treatment. ED asthma visits were those with documented asthma treatment. Generalized liner models were used to analyze the association between numbers of AM visits and acute asthma visits to the ED and PCP. Results One hundred three subjects were analyzed. Over the 3 years, the mean number of AM visits/child was 2.5 ± 2.3 (standard deviation), range 0–10. Only 50% of subjects had at least 1 PCP visit with an asthma controller medication documented. The mean number of ED asthma visits/child was 3.2 ± 2.8; range 1–18. The mean number of PCP Acute Asthma visits/child was 0.7 ± 1.6; range 0–11. Increasing AM visits was associated with more ED visits (estimate 0.088; 95% CI 0.001, 0.174), and more PCP Acute Asthma visits (estimate 0.297; 95% CI 0.166, 0.429). Increasing PCP visits for any diagnosis was not associated with ED visits (estimate 0.021; 95% CI −0.018, 0.06). Conclusions Asthma monitoring visits and documented controller medication for these urban Medicaid-insured children occurred infrequently over 3 years, and having more asthma monitoring visits was not associated with fewer ED or PCP acute asthma visits.

Characteristics of Pediatric Emergency Revisits After an Asthma-Related Hospitalization

“…This approach is consistent with previous literature in regard to categorization of an emergency visit as “asthma related” according to documented asthma medications administered or prescribed at the visit. 30 Neither parental nor physician subjective impression of symptom severity was a factor in the categorization of revisits.…”

Asthmatic patient’s preferences regarding frequency of physician consultation

“…Studies suggested that follow-up visits help physicians to regularly evaluate asthma risk and alter treatment if required ( Nelson et al, 2014 ). These visits may also help in solving the issues of poor inhaler technique and failure to proper asthma control.…”

Common step-wise interventions improved primary care clinic visits and reduced emergency department discharge failures: a large-scale retrospective observational study

“…Different findings are reported among the current literature regarding the association between patient PCP clinic follow-up compliance and ED returns/revisits [11, 19]. Some studies focusing on asthma patients revealed the value of urgent PCP follow-ups [22] and their impact on decreased ED returns [23], while others yielded opposite findings [24, 25]. Patients with Medicare/Medicaid tended to have more ED returns regardless of PCP clinic visits [26, 27].…”