The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

A TEN-YEAR EMERGENCY ROOM ASTHMA EDUCATION AND FOLLOW-UP PROGRAM

Chris Garvey ,1GeneAnn La Moria ,1Monte Schactner ,1 Stephen Park ,1



Background: Twenty million Americans have asthma and over half report an asthma attack in the last year. There are 1.8 ER asthma visits annually in ths US.1 According to the NAEPP EPR-3, persons requiring ER care for asthma exacerbation need referral for follow-up asthma care and discharge instructions including use of medications and inhaler technique.2 Healthy People 2010 objectives include reducing asthma hospitalizations and ER visits through formal patient education and appropriate asthma care based on the NAEPP guidelines.3 Coordinated asthma care that focuses on promoting patient self-management strategies and collaboration with the PCP may reduce asthma ER visits and hospitalizations through improved control and management of asthma.

Methods:
2341 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 12/07. All patients received a standardized intervention provided by respiratory care practitioners based on the NAEPP Guidelines for the Diagnosis and Management of Asthma'2. The interventions included: patient education about disease process and control strategies, trigger identification and control, use of inhaler, holding chamber and peak flow meter, need for PCP follow-up, 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 the sample, 55% (n=1283) received telephone follow-up within 4 days of the ER visit. Forty-five percent (n=1058) did not answer 3 phone calls. Three months after the initial asthma visit and intervention, respiratory ER and 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 3% and hospital admissions for asthma decreased from 6% to a current rate of 1%. Declines in ER return rate and asthma hospitalization have been maintained for the following 10 years of the study.
1 cdc.gov/mmwr/preview/mmwrhtml/ss5608a1.htm
2 nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
3 healthypeople.gov/Document/HTML/Volume2/24Respiratory.htm