Effects of increased primary care access on process of care and health outcomes among patients with asthma who frequent emergency departments.
OBJECTIVE
Many asthmatic patients discharged from emergency departments do not have timely follow-up visits with a primary care physician. This study was conducted to determine the effectiveness of a health professional-based intervention in improving process of care and health outcomes among asthmatic patients discharged from emergency departments.


METHODS
We enrolled 125 asthmatic patients, aged 5 through 50 years, from the emergency department of a community-based hospital; 62 patients were assigned to usual care and 63 to enhanced care. Enhanced care consisted of usual care plus employment of a coordinator to make follow-up appointments with the patient's primary care physician with at least one reminder telephone call to the patient.


RESULTS
At 6 months of follow-up, mean (+/- SD) asthma and pediatric quality-of-life scores were higher in the enhanced care group than in the usual care group (5.7 +/- 1.2 units vs. 5.0 +/- 1.3 units, P = 0.01). The enhanced care group also had a higher rate of follow-up office visits (78% [n = 44] vs. 60% [n = 33], P = 0.003), were more likely to have written action plans (46% [n = 26] vs. 25% [n = 14], P = 0.02), and had fewer asthma symptoms (1.8 +/- 1.1 units vs. 2.2 +/- 1.3 units, P = 0.09). However, these differences disappeared by 12 months of follow-up.


CONCLUSIONS
A simple intervention wherein a health professional facilitates follow-up visits can improve the process of care and health outcomes of high-risk asthmatic patients. However, the effect of this intervention is time limited and largely wears off by 12 months.
James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, Department of Medicine (Pulmonary Division), University of British Columbia, Vancouver, Canada. dsin@mrl.ubc.ca
Don D
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D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000592:standards*; D000416:Alberta; D001249:Asthma / Q000523:psychology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000592:standards*; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000592:standards*; D015397:Program Evaluation; D011788:Quality of Life; D017010:Reminder Systems / Q000592:standards; D012720:Severity of Illness Index; D017749:Total Quality Management / Q000458:organization & administration