2004 OPEN FORUM Abstracts
A SIX-YEAR ER ASTHMA EDUCATION AND FOLLOWUP PROGRAM
Chris
Garvey, FNP, MSN, MPA, GeneAnn La Moria, RRT, BS,
Charlene Kelly, RRT, Stephen Park, MD
Seton
Medical Center, Daly City, CA.
BACKGROUND: In the US, the rates of deaths from asthma, hospitalizations
and
visits to emergency rooms have been increasing for more than 20 years
(NHLBI, 2001). A coordinated
model of asthma care that focuses on maximizing patient
self-management techniques and partnership with the primary care
provider (PCP) may reduce overall asthma emergency room visit and
hospitalization rates through improved control of asthma.
METHOD:
1844 patients with moderate persistent to severe persistent asthma
(based on self-report of daily or more frequent asthma symptoms) were
seen for ER care at our private community hospital between 2/98 and
12/03. All patients received a standardized intervention provided by
respiratory care practitioners (RCPs) based on the 1997 NIH
‘Guidelines for the Diagnosis and Management of Asthma’.
The interventions included: education about disease process and
control methods, trigger identification and control, use of MDI and
holding chamber, peak flow meter use, importance of reporting of
asthma symptoms to the PCP, need for follow-up with PCP, regular use
of ‘controller’ medication, and referral to free
community asthma education class. Phone follow-up within 4 days of
ER asthma visit included assessment of asthma-related symptoms,
medication and peak flow adherence, patient follow-up with PCP, and
education of disease self-management techniques. For all patients in
the sample, 55% (n=1029) received telephone follow-up within 4 days
of ER visit. Forty-five percent (n=815) did not answer 3 phone
calls. Three months after the initial ER asthma visit and
intervention, respiratory ER and respiratory hospitalization revisit
rate were assessed by medical record review of all patients.
RESULTS:
For the total sample, ER revisit rate for respiratory illness within
3 months of ER asthma intervention decreased 50% and hospital
admission for respiratory illness decreased 66% after the first year
of the study and the decline was maintained for the following 5 years
of the study.
CONCLUSION: Patients demonstrate decreased respiratory
ER visits and respiratory hospitalizations after a standardized
asthma ER intervention provided by RCPs.
Asthma ER Visit and
Hospitalization Rate Three Months after Intervention
| Year | 1st qtr 1998 | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 |
| ER revisit | 53% | 18% | 9% | 8% | 3% | 4% | 6% |
| Resp Hosp | 11% | 6% | 2% | 2% | 3% | 1% | 1% |