Beliefs and barriers to follow-up after an emergency department asthma visit: a randomized trial.
BACKGROUND
Studies in urban emergency departments (EDs) have found poor quality of chronic asthma care and identified beliefs and barriers associated with low rates of follow-up with a primary care provider (PCP).


OBJECTIVE
To develop an ED-based intervention including asthma symptom screening, a video addressing beliefs and a mailed reminder; and measure the effect on PCP follow-up and asthma-related outcomes.


METHODS
This randomized, controlled trial enrolled children aged 1 to 18 years who were discharged after asthma treatment in an urban pediatric ED. Control subjects received instructions to follow-up with a PCP within 3 to 5 days. In addition, intervention subjects (1) received a letter to take to their PCP if they screened positive for persistent asthma symptoms, (2) viewed a video featuring families and providers discussing the importance of asthma control, and (3) received a mailed reminder to follow-up with a PCP. All subjects were contacted by telephone 1, 3, and 6 months after the ED visit, and follow-up was confirmed by PCP record review. Asthma-related quality of life (AQoL), symptoms, and beliefs about asthma care were assessed by using validated surveys.


RESULTS
A total of 433 subjects were randomly assigned, and baseline measures were similar between study groups. After the intervention and before ED discharge, intervention subjects were more likely to endorse beliefs about the benefits of follow-up than controls. However, rates of PCP follow-up during the month after the ED visit (44.5%) were similar to control subjects (43.8%) as were AQoL, medication use, and ED visits.


CONCLUSIONS
An ED-based intervention influenced beliefs but did not increase PCP follow-up or asthma-related outcomes.
Children's Hospital of Philadelphia, Division of Emergency Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA. zorc@email.chop.edu
Joseph J
JJ
Zorc
Amber
A
Chew
Julian L
JL
Allen
Kathy
K
Shaw
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001071:Appointments and Schedules; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology*; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D003144:Communication Barriers; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003469:Culture; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D012016:Reference Values; D017010:Reminder Systems; D012307:Risk Factors; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric; D014481:United States
D018927:Anti-Asthmatic Agents