Randomized Controlled Trial of Emergency Department Interventions To Improve Primary Care Follow-up for Patients With Acute Asthma

Baren, Jill M.; Boudreaux, Edwin D.; Brenner, Barry E.; Cydulka, Rita K.; Rowe, Brian H.; Clark, Sunday; Camargo, Carlos A.

doi:10.1378/chest.129.2.257

Cited by 140 publications

(169 citation statements)

References 25 publications

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“…There is some evidence that scheduling fixed appointments following acute consultation is effective in improving attendance for reviewing chronic conditions such as asthma, although the long-term benefits in terms of reduced exacerbations are unclear. [15][16][17] We could find no comparable evidence about safety-netting, and no clear consensus of clinical opinion.…”

Section: Saying More Precisely How To Seek Further Carementioning

confidence: 87%

Diagnostic safety-netting

Almond¹,

Mant²,

Thompson³

2009

Br J Gen Pract

128

123

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Section: Saying More Precisely How To Seek Further Carementioning

confidence: 87%

Diagnostic safety-netting

Almond¹,

Mant²,

Thompson³

2009

Br J Gen Pract

128

123

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“…18,19 Studies conducted in other patient populations have shown that telephone follow-up encourages compliance with discharge instructions and increases the likelihood of physician follow-up. [20][21][22][23] Prior work has also shown that telephone follow-up interviews are feasible among older patients discharged from the ED. 19 Telephone follow-up with discharged older adults or their caregivers may be a low-cost and practical strategy to increase care plan compliance.…”

mentioning

confidence: 99%

A Randomized Trial Exploring the Effect of a Telephone Call Follow‐up on Care Plan Compliance Among Older Adults Discharged Home From the Emergency Department

Biese

LaMantia

Shofer

et al. 2014

Academic Emergency Medicine

120

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Objectives: Older patients discharged from the emergency department (ED) have difficulty comprehending discharge plans and are at high risk of adverse outcomes. The authors investigated whether a postdischarge telephone call-mediated intervention by a nurse would improve discharge care plan adherence, specifically by expediting post-ED visit physician follow-up appointments and/or compliance with medication changes. The second objectives were to determine if this telephone call intervention would reduce return ED visits and/or hospitalizations within 35 days of the index ED visit and to determine potential cost savings of this intervention.Methods: This was a 10-week randomized, controlled trial among patients aged 65 and older discharged to home from an academic ED. At 1 to 3 days after each patient's index ED visit, a trained nurse called intervention group patients to review discharge instructions and assist with discharge plan compliance; placebo call group patients received a patient satisfaction survey call, while the control group patients were not called. Data collection calls occurred at 5 to 8 days and 30 to 35 days after the index ED visits for all three groups. Chi-square or Fisher's exact tests were performed for categorical data and the Kruskal-Wallis test examined group differences in time to follow-up.Results: A total of 120 patients completed the study. Patients were 60% female and 72% white, with a mean age of 75 years (standard deviation [SD] AE 7.58 years). Intervention patients were more likely to follow up with medical providers within 5 days of their ED visits than either the placebo or the control group patients (54, 20, and 37%, respectively; p = 0.04). All groups performed well in medication acquisition and comprehension of medication indications and dosage. There were no differences in return visits to the ED or hospital within 35 days of the index ED visit for intervention patients, compared to placebo or control group patients (22, 33, and 27%, respectively; p = 0.41). An economic analysis showed an estimated 70% chance that this intervention would reduce total costs. Conclusions:Telephone call follow-up of older patients discharged from the ED resulted in expedited follow-up for patients with their primary care physicians. Further study is warranted to determine if

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“…The current authors believe that the PCE process goes part way to addressing a number of the patient education issues facing health professionals, such as the diverse perspectives of patients and health professionals and the difficulty health professionals face in translating clinical guidelines to patients [35][36][37]. Some ED studies of patients with acute asthma have focused on improving primary care follow-up through telephone reminders [15] and primary care-based education [16], which have shown very little or no improvement in patient behaviour or asthma outcomes. Furthermore, a disproportionately high number of patients who do not have regular contact with their GP are admitted to hospital after seeking emergency care [38].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies of patients with acute asthma have focused interventions on improving primary care follow-up via telephone reminders [15] and primary care-based education [16], which have shown very little or no improvement in patient behaviour or asthma outcomes. Patient education has been described as an essential component of asthma management, with clinical guidelines providing the basis for both clinical management and education curricula [17].…”

mentioning

confidence: 99%

Standard versus patient-centred asthma education in the emergency department: a randomised study

Smith

Mitchell²,

Bowler³

2008

European Respiratory Journal

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High re-attendance rates are common after asthma emergency department (ED) care. Inadequate patient education has been cited as a potential cause of re-attendance and the optimal format of education is uncertain. The present study aimed to compare the effectiveness of patient-centred education (PCE) and standard asthma patient education on ED re-attendance.A randomised controlled trial was conducted at two inner-city Australian teaching hospitals' EDs, where patients received either standard patient education (SPE) or PCE. Both groups received a six-topic curriculum. However, PCE patients reordered the topics according to their own priority and thus controlled the order of education.In total, 146 adult patients presenting to EDs with acute asthma were enrolled. After 4 months, ED re-attendance decreased from 22 to 12% in the PCE group and remained unchanged in the SPE group (between group odds ratio 0.4, 95% confidence interval (0.2-1.1)). In 78 patients discharged after ED care, the PCE group had fewer re-attendances after 4 and 12 months (0.3 (0.1-0.9) and 0.3 (0.1-0.8), respectively ). PCE patients with no general practitioner care in the preceding 7 days had fewer re-attendances after 4 and 12 months (0.1 (0.0-0.7) and 0.2 (0.0-0.6), respectively). A trend of better asthma control was evident, with a reduction in activity limitation.In conclusion, patient-centred education offers promise as a brief education process in the emergency department. However, a large multicentre trial of patient-centred education is required.

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Randomized Controlled Trial of Emergency Department Interventions To Improve Primary Care Follow-up for Patients With Acute Asthma

Cited by 140 publications

References 25 publications

Diagnostic safety-netting

Diagnostic safety-netting

A Randomized Trial Exploring the Effect of a Telephone Call Follow‐up on Care Plan Compliance Among Older Adults Discharged Home From the Emergency Department

Standard versus patient-centred asthma education in the emergency department: a randomised study

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