PHILADELPHIA- Follow-up with a primary care physician after emergency department (ED) treatment for acute asthma improves symptom control and reduces the risk of hospitalization. Few studies have scientifically assessed specific interventions to facilitate such follow-up. However, the results of a recent randomized controlled trial have now shown that a low-cost ED intervention is effective in this regard.[1]

The intervention was simple. In addition to providing short-course prednisone, ED staff gave patients vouchers for transportation to and from the primary care provider; patients also received post-discharge telephone calls to remind them to visit that provider. Of the patients given the intervention, 46% saw their primary care provider within four weeks of their asthma exacerbation. In contrast, only 29% of the control group did so.

“The intervention only costs about $15 per patient,” estimated lead investigator Jill M. Baren, MD, in an interview with RESPIRATORY REVIEWS. Dr. Baren is an Assistant Professor of Emergency Medicine at the University of Pennsylvania in Philadelphia.

PATIENTS PROSPECTIVELY SCREENED

Patients ages 17 to 45 years with a chief presenting complaint suggesting an asthma exacerbation were prospectively screened for the trial. Following randomization, the intervention group received oral prednisone (50 mg/d for five days), two taxicab vouchers, an asthma information card, and written instructions for the use of their Medications and vouchers. The telephone reminders came within 48 hours of ED discharge.

The control group received discharge instructions and medication prescriptions at the treating physician’s discretion. Patients in both groups who did not have a primary care provider were directed to a hospital-based asthma clinic that had agreed to accept referrals from the trial. Four weeks after discharge, an investigator called the patients’ primary care providers and the clinic to determine if follow-up had taken place.

Between March and November 1998, 192 patients were enrolled in the trial. Of these, 14 were lost to follow-up, leaving 95 patients in the intervention group and 83 in the control group. At baseline, the two groups were similar in age, sex, ethnicity, and educational level. They were also similar in the severity of their asthma exacerbations and their access to medical care.

The 17% absolute increase in the follow-up rate (from 29% to 46%) translated into an almost 60% relative increase in the likelihood that patients would see a primary care provider. Furthermore, when the analysis was controlled for factors known to influence follow-up rates, the intervention group was shown to be three times more likely to see a primary care provider.

A major barrier to appropriate management is that many people see asthma as an episodic disease calling for crisis-oriented care, commented Dr. Baren. “But it is a chronic, lifelong disease that requires longitudinal care, so the onus is on us in the [ED] to see that patients with asthma get that type of care,” she said.

--Timothy Begany