EMERGENCY DEPARTMENT-BASED ASTHMA INTERVENTION

OVERVIEW

This brief Emergency Department-based intervention is designed to assist families of children with asthma to better manage their child’s asthma. Two variations of the program have been developed and evaluated. In one program, study staff assisted families in scheduling a follow-up appointment with a primary care physician while still in the emergency department. In the modified program, study staff presented families, while still in the emergency department, with a brief video discussing asthma and asthma management and sent reminder postcards to schedule a follow-up appointment with a primary care physician. In an evaluation of the first version of the program, patients in the treatment group were more likely to have a follow-up physician visit; but no impacts were found on return visits to the emergency department for asthma or using a daily asthma controller medication. In an evaluation of the modified program, there were no impacts on following-up with a primary care physician, asthma symptoms, asthma quality of life, and subsequent asthma-related emergency department visits or hospitalizations.

DESCRIPTION OF PROGRAM

Target population: Children with asthma residing in the inner-city.

This brief emergency department-based intervention is designed to assist families of children with asthma in scheduling a follow-up appointment with a primary care provider prior to their discharge from the emergency department. Study staff are stationed in the emergency department between 8 AM and 12 midnight, seven days a week. Together with the parent/guardian, study staff attempt to call a primary care physician to schedule an asthma follow-up appointment for the family. If unable to schedule an appointment prior to discharge from the emergency department, study staff offer to continue attempting to schedule a follow-up appointment or, if parents are available during the daytime, study staff setup a conference call so that staff and parents can, together, attempt to schedule an asthma follow-up appointment with a primary care physician. In addition, when an appointment is made, study staff fax copies of emergency department medical records to the primary care physician for the follow-up visit.

Based on an evaluation of this program (Zorc et al,, 2003), adjustments were made (Zorc et al,, 2009), which now focus more on addressing beliefs and barriers to receiving asthma follow-up care rather than scheduling a follow-up appointment with a primary care physician. In the modified program, three components are included. While in the emergency department, a brief video is shown to families depicting other families with children with well-controlled asthma discussing beliefs and misconceptions about asthma and asthma follow-up care (such as, “What is asthma?”; “How can asthma be controlled?”; and, “What are the benefits of controlling asthma?”). A reminder postcard is mailed to families to schedule a follow-up appointment with a primary care physician and discuss ways to control asthma. Also, if children are screened to have “persistent” asthma, families are mailed these results.

EVALUATION(S) OF PROGRAM

Zorc JJ, Scarfone RJ, Li Y, Hong T, Harmelin M, Grunstein L, Andre JB. (2003). Scheduled Follow-up After a Pediatric Emergency Department Visit for Asthma: A Randomized Trial. Pediatrics, 111(3):495-502.

Evaluated population: A total of 278 children between 2 and 18 years of age were enrolled in the study. The average age was approximately eight years. Among study participants, 62% were male, 94% were black, 62% were insured through Medical Assistance, 55% had two or more emergency department visits/hospitalizations for asthma-related problems within the past year, and 70% had baseline “persistent” asthma symptoms.

Approach: Families were enrolled in the study while still in the emergency department. Children were approached for the study if they met the following criteria: 2-18 years of age; family resides within Philadelphia, PA; two or more previous medical visits for asthma in which bronchodilators were prescribed; acute respiratory symptoms requiring emergency department treatment with bronchodilators; child not admitted to the hospital for further treatment or observation; and the family had a telephone and an English speaker in the home. Children were randomly assigned to the intervention group (n=139) or the control group (n=139). Control group participants were given standard discharge instructions to follow-up with their primary care physician within three to five days after the emergency department visit.

Participants were assessed on demographic characteristics and asthma history and treatment. Between four and six weeks after the emergency department visit, a telephone interview was conducted with study participants, using a validated survey instrument. Families were assessed on the participant’s symptoms since the emergency department visit, date of follow-up, interventions that had taken place, and, if applicable, reason(s) for no primary care physician follow-up. Copies of medical records for each visit were reviewed, where possible, to confirm information collected during telephone interviews.

Results: Four weeks after the emergency department visit, participants in the intervention group were significantly more likely to report a return to baseline health and seeing a primary care physician compared with the control group. There were no significant differences between the two study groups on a return visit to the emergency department, missing school, parents/guardians missing work, and using a daily controller medication.

An analysis of a subset of intervention (n=68) and control (n=67) participants for subsequent primary care physician visits and asthma-related emergency department visits and hospitalizations one year after the intervention found no significant differences in the number of primary care physician visits and asthma-related emergency department visits. However, the intervention group was significantly more likely than the control group to have an asthma-related hospitalization one year after the emergency department-based intervention.

The authors note study staff expressed difficulty in scheduling appointments for families while in the emergency department, especially after physician office hours.

Zorc JJ, Chew A, Allen JL, Shaw K. (2009). Beliefs and Barriers to Follow-up After an Emergency Department Asthma Visit: A Randomized Trial. Pediatrics, 124(4): 1135-1142.

Evaluated population: A total of 433 children between 1 and 18 years of age were enrolled in the study, with a mean age of seven years. The majority of study participants were male (62%), approximately 94% were black, and more than two-thirds were insured through Medical Assistance. In addition, 50% of study participants had baseline “persistent” asthma symptoms.

Approach: Families were enrolled in the study while still in the emergency department. The same inclusion criteria were used for this study as in the Zorc et al. (2003) study, except children could be between 1 and 18 years of age. Children were randomly assigned to the intervention group (n=217) or the control group (n=216). Control group participants were given standard discharge instructions to follow-up with their primary care physician within three to five days after the emergency department visit.

Parents/guardians were assessed on the benefits and barriers to follow-up care prior to leaving the emergency department. In addition, parents/guardians were contacted, via telephone, at one, three, and six months after the emergency department visit to assess: child’s symptoms since emergency department visit, date of follow-up care, subsequent asthma-related emergency department visits, interventions that had taken place, and asthma quality of life. Copies of medical records for each visit were reviewed, where possible, to confirm information collected during telephone interviews.

Results: At follow-up assessments, there were no differences between the two study groups for following-up with a primary care physician, asthma symptoms, asthma quality of life, and subsequent asthma-related emergency department visits and hospitalization.

At the end of the emergency department visit, intervention families expressed more positive beliefs, compared with those in the control group, about whether children who regularly visit their primary care physician have fewer emergency department visits, miss fewer days of school, or have fewer asthma symptoms. However, these findings did not remain at the three-month follow-up period.

SOURCES FOR MORE INFORMATION

References

Zorc JJ, Chew A, Allen JL, Shaw K. (2009). Beliefs and Barriers to Follow-up After an Emergency Department Asthma Visit: A Randomized Trial. Pediatrics, 124(4): 1135-1142.

SUMMARY & CATEGORIZATION

Evaluated participant ages: Children (3-11)

Program components: Clinic/Provider-based

Measured outcomes: Physical Health

KEYWORDS: Children (3-11), Urban, Black/African-American, Parent Training/Education, Health Status/Conditions, Attendance, Clinic/Provider-Based

Program information last updated on 2/24/10.

		© Child Trends 2004