Asthma education and specialized care after pediatric emergency department visits: Real-life impact

Abstract

BACKGROUND: Although asthma education and medical follow-up improve asthma control in efficacy trials, implementation issues may affect real-life effectiveness. OBJECTIVES: To assess the real-life impact of asthma education and/or specialized asthma care (SAC), in children referred to the Asthma Education Center (AEC) following an emergency department (ED) visit for asthma. METHODS: We conducted a retrospective cohort study of children aged 0-17 years, presenting to the ED between 2001 and 2006 for asthma, and referred to the AEC. Patients were considered exposed to AEC or SAC from their first visit, exposed to both AEC and SAC when both services had been received and unexposed otherwise. A Cox proportional hazards model was used to estimate the association of AEC and/or SAC with time-to-subsequent asthma ED visit in the 12 months following the index visit. RESULTS: Of the 1,233 children (mean age: 4.4 years; 63.5% male), 46% received both AEC and SAC; 19%, AEC alone, and 8%, SAC alone; 56% AEC with SAC occurring <1 month of the index ED visit. Compared to unexposed, the likelihood (HR [95% CI]) of a subsequent ED visit was significantly lower in children receiving AEC with SAC (0.43 [0.34, 0.53]) and AEC alone (HR = 0.68 [0.53, 0.86]), but not in those receiving SAC alone (HR = 0.85 [0.64, 1.14]). CONCLUSION: Following an AEC referral after an ED visit, children who received AEC alone or with SAC, had a lower likelihood of a subsequent ED visit; no significant reduction was noted with SAC alone, underlying the real-life effectiveness and importance of asthma education.