A multifaceted intervention to improve asthma control via asthma education, medical follow-up and regular self-monitoring after pediatric emergency department visits for asthma

Abstract

BACKGROUND Repeated emergency department (ED) visits for acute asthma signal poor asthma control. OBJECTIVE We examined the effectiveness of a multifaceted intervention initiated in the ED to promote asthma education, medical visits and regular self-monitoring and to reduce morbidity following an acute care visit for asthma in children. METHODS We conducted a single-blind randomized controlled trial in children aged 5–17 years presenting for a second or more ED visits for asthma in the past year. The main outcome was the risk of asthma acute care visits. RESULTS We randomized 298 children to usual care (N = 127) and the intervention (N = 171); Children were mostly Caucasians with a median (25%, 75%) age of 8 (6, 11) years. Compared to usual care, significantly more intervention patients attended a medical follow-up visit (32% vs 20%, RR: 1.54 [95%CI: 1.03, 2.32]) and an asthma education session (28% vs 9%, RR: 3.24 [1.75, 5.99]) within 4 weeks of the ED visit. There was no significant group difference in the risk of acute care visits over the next year (RR: 0.92 [0.71, 1.19]). CONCLUSIONS In asthmatic children with recurrent ED visits, promotion of asthma education, medical follow-up visits, asthma control awareness and self-monitoring increased attendance to asthma education and medical follow-up within 4 weeks of the index visit, without reducing exacerbations requiring health care resources.