Effectiveness of Educational Interventions to Increase Primary Care Follow-up for Adults Seen in the Emergency Department for AcuteAsthma: A Systematic Review and Meta-analysis.

Abstract

Patients with asthma commonly present to emergency departments (ED) with exacerbations. Asthma guidelines recommend close follow-up with a primary care provider (PCP) after ED discharge; however, this linkage is often delayed or absent. The objective of this study was to assess whether ED-directed educational interventions improve office follow-up with PCPs after ED discharge for acute asthma. Comprehensive literature searches were conducted in seven electronic databases (1946 to 2014). Randomized controlled clinical trials examining the effectiveness of educational interventions to increase office follow-up with a PCP were included. Study quality was determined using the Cochrane risk of bias tool; fidelity of the interventions was assessed using the Treatment Fidelity Assessment Grid. Using study data, risk ratios (RRs),and the number needed to treat for benefit (NNTB) with 95% confidence intervals (CI) were calculated using random-effects models. From 427 potentially relevant studies, five (n=825) were included. The overall risk of bias was unclear, and the description of intervention fidelity varied across the studies. Educational interventions targeting either patients or PCPs led to a greater likelihood of having primary care follow-up after ED discharge (RR=1.6; 95% CI=1.31 to 1.87; I(2) =0%). The number needed to treat for benefit was six (95% CI=4 to 11). No significant benefit was observed in reductions of relapses (RR=1.3; 95% CI=0.82 to 1.98; I(2) =23%) and admissions (RR=0.51; 95% CI=0.24 to 1.06; I(2) =0%). Due to the small number of studies for each comparison, publication bias was not formally assessed. ED-directed educational interventions targeting either patients or providers increase the chance of having office follow-up visits with PCPs after asthma exacerbations. Their impact on health-related outcomes (e.g., relapse and admissions) remains unclear.