OBJECTIVE: To determine if an emergency department-based asthma follow-up clinic could improve outcomes within a high-morbidity pediatric population. DESIGN: Prospective, randomized clinical trial with 6 months of follow-up. SETTING:Emergency department of an urban pediatric medical center. PARTICIPANTS: Convenience sample of 488 patients aged 12 months to 17 years, inclusive, with prior physician-diagnosed asthma and 1 or more other unscheduled visits in the previous 6 months and/or 1 or more hospitalizations in the prior 12 months. INTERVENTION: Single follow-up clinic visit focusing on 3 domains: asthma self-monitoring and management, environmental modification and trigger control, and linkages and referrals to ongoing care. MAIN OUTCOME MEASURES: The primary outcome measure was unscheduled visits for acute asthma care. Secondary outcomes included compliance with a medical plan and asthma quality of life. Analysis was by intention to treat with adjustment for baseline differences. RESULTS: Of those randomized to the clinic visit, 172 (70.5%) of 244 attended. The intervention group had significantly fewer mean unscheduled visits for asthma care during follow-up (1.39 vs 2.34; relative risk [RR] = 0.60 [95% confidence interval (CI), 0.46-0.77]). At 6 months, significantly more patients in the intervention group reported use of inhaled corticosteroids in the prior 2 days (49.3% vs 26.5%; RR = 2.03 [95% CI, 1.57-2.62]), no limitation in daytime quality of life (43.8% vs 34.4%; RR = 1.36 [95% CI, 1.06-1.73]), and no functional limitations in quality of life (49.8% vs 40.8%; RR = 1.33 [95% CI, 1.08-1.63]). CONCLUSION: Attendance in the follow-up clinic was high. The intervention decreased subsequent unscheduled health care use while improving compliance and quality of life.
RCT Entities:
OBJECTIVE: To determine if an emergency department-based asthma follow-up clinic could improve outcomes within a high-morbidity pediatric population. DESIGN: Prospective, randomized clinical trial with 6 months of follow-up. SETTING: Emergency department of an urban pediatric medical center. PARTICIPANTS: Convenience sample of 488 patients aged 12 months to 17 years, inclusive, with prior physician-diagnosed asthma and 1 or more other unscheduled visits in the previous 6 months and/or 1 or more hospitalizations in the prior 12 months. INTERVENTION: Single follow-up clinic visit focusing on 3 domains: asthma self-monitoring and management, environmental modification and trigger control, and linkages and referrals to ongoing care. MAIN OUTCOME MEASURES: The primary outcome measure was unscheduled visits for acute asthma care. Secondary outcomes included compliance with a medical plan and asthma quality of life. Analysis was by intention to treat with adjustment for baseline differences. RESULTS: Of those randomized to the clinic visit, 172 (70.5%) of 244 attended. The intervention group had significantly fewer mean unscheduled visits for asthma care during follow-up (1.39 vs 2.34; relative risk [RR] = 0.60 [95% confidence interval (CI), 0.46-0.77]). At 6 months, significantly more patients in the intervention group reported use of inhaled corticosteroids in the prior 2 days (49.3% vs 26.5%; RR = 2.03 [95% CI, 1.57-2.62]), no limitation in daytime quality of life (43.8% vs 34.4%; RR = 1.36 [95% CI, 1.06-1.73]), and no functional limitations in quality of life (49.8% vs 40.8%; RR = 1.33 [95% CI, 1.08-1.63]). CONCLUSION: Attendance in the follow-up clinic was high. The intervention decreased subsequent unscheduled health care use while improving compliance and quality of life.
Authors: Margaret E Samuels-Kalow; Karin V Rhodes; Mira Henien; Emily Hardy; Thomas Moore; Felicia Wong; Carlos A Camargo; Caroline T Rizzo; Cynthia Mollen Journal: Acad Emerg Med Date: 2017-04-24 Impact factor: 3.451
Authors: Michelle Boyd; Toby J Lasserson; Michael C McKean; Peter G Gibson; Francine M Ducharme; Michelle Haby Journal: Cochrane Database Syst Rev Date: 2009-04-15
Authors: Sande O Okelo; Arlene M Butz; Ritu Sharma; Gregory B Diette; Samantha I Pitts; Tracy M King; Shauna T Linn; Manisha Reuben; Yohalakshmi Chelladurai; Karen A Robinson Journal: Pediatrics Date: 2013-08-26 Impact factor: 7.124