2006 OPEN FORUM Abstracts
AN EIGHT-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: An estimated 20 million Americans have asthma. 1 Nearly 1.9 million ER visits were attributed to asthma in 2002.2 Objectives of Healthy People 2010 include reducing asthma hospitalizations and
ER visits and increasing the number
of persons with asthma who receive formal patient education, including
community and self-help resources and appropriate asthma care according to the
NAEPP Guidelines.3 Coordinated asthma care that
focuses on promoting patient self-management strategies and collaboration with
the primary care provider (PCP) may reduce overall asthma emergency room visits
and hospitalizations through improved control and management of asthma.
Method: 2152 patients with moderate 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 12/05. All patients received a standardized
intervention provided by respiratory care practitioners (RCPs) based on the
NAEPP Guidelines for the Diagnosis and Management of Asthma4.
The interventions included: patient education about disease process and control
strategies, trigger identification and control, use of MDI, holding chamber and
peak flow meter, need for PCP follow-up and prompt reporting of asthma
symptoms, regular use of 'controller' medication, and referral to free
community asthma education classes. 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, 54 % (n=1170) received telephone follow-up within 4 days of the
ER visit. Forty-six percent (n = 982) did not answer 3 phone calls. Three
months after the initial ER asthma visit and intervention, respiratory ER and
respiratory hospitalization revisit rates were assessed by medical record
review of all patients.
Results: For the total sample, ER revisit rate for
asthma within 3 months of ER asthma intervention decreased from 18% in 1998 to
a current rate of 2% and hospital admissions for asthma decreased from 6% in
1998 to a current rate of 3%. Declines in ER asthma return rates and
asthma-related hospitalizations have been maintained for the following 7 years
of the study.
Asthma ER Visit and
Hospitalization Rate Three Months after Intervention
| Year | 1998 | 1999 | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 |
| Total pts | 130 | 354 | 421 | 360 | 314 | 264 | 140 | 169 |
| ER visit | 18% | 9% | 8% | 3% | 4% | 6% | 1% | 2% |
| Resp Hosp | 6% | 2% | 2% | 3% | 1% | 1% | 1% | 3% |
Conclusion: Patients demonstrate decreased asthma ER visits and
asthma-related hospitalizations after a standardized asthma ER intervention
provided by RCPs.
References
1.
National Center for Health Statistics. Raw Data from the National
Health Interview Survey, U.S., 2003. (Analysis by the ALA, Using SPSS and
SUDAAN software).
2.
National Center for Health Statistics. National Hospital Ambulatory
Medical Survey, 2002. (Analysis by the American Lung Association, Using SPSS
and SUDAAN software).
3.
US Department of HHS. Respiratory diseases [Goal 24]. In: Healthy
people 2010 (conference ed., vol II). Washington, DC: US Department of Health
and Human Services, 2000;24-1-27.
4.
NIH, National Asthma Education Program. NAEPP Expert Panel Report.
Guidelines for the Diagnosis and Management of Asthma-Update on Selected Topics
2002. Bethesda, MD.