Impact of Follow-Up by The Primary Care Or Specialist Physician on Pediatric Asthma Outcomes after An Emergency Department Visit: The Case of Montreal, Canada

Abstract

The purpose of this study was to determine follow-up practices subsequent to an emergency department (ED) visit for asthma in Montreal, Canada, among children 1–14 years old and the links to improved asthma outcomes. Appropriate asthma management enables better control of asthma and can lead to decrease in the risk of ED visits and repeated hospitalizations. Telephone interviews with parents of children aged 1–14 years old who had an ED visit for asthma (n = 267) were conducted 3 to 7 days after the index ED visit. Additional mailed questionnaires and interviews were conducted at 6 and 12 months after the index ED visit. Multivariate logistic regression was used to analyze the impact of follow-up by the primary care provider or (PCP) specialist physician on ED visits and asthma control. One month after the index ED visit, 52% of 267 children had no PCP. This proportion decreased to 37% of the children who remained in the study after 1 year. One year after the index ED visit, 51% had had at least one subsequent ED visit and 25% showed poor asthma control. Children without a PCP at any assessment were more likely to have at least one other ED visit compared to those who had a PCP throughout the year. The children without a PCP were less likely overall to exhibit effective asthma control. This study raises concerns related to the high proportion of children with asthma without a PCP and the link to asthma outcomes. Therefore, it appears necessary to further explore the reasons for not having a PCP and find ways to promote better continuity of care. (Pediatr Asthma Allergy Immunol 2007; 20[1]:23–35.)