Improving care for asthma

Abstract

To the Editor: The study by Smith et al1Smith S.R. Jaffe D.M. Fisher E.B. Trinkaus K.M. Highstein G. Strunk R.C. Improving follow-up for children with asthma after an acute emergency department visit.J Pediatr. 2004; 145: 772-777Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar in the recent issue of the Journal describes a randomized controlled trial to evaluate the effectiveness of telephone asthma coaching and a monetary incentive to improve post-emergency department (ED) visit follow-up, as well as asthma outcomes over the 6 months after the ED visit. The authors reported an increase of follow-up asthma visits and decreased asthma symptoms in the immediate post-ED visit period (within 15 days). However, there was no increase in subsequent asthma follow-up visits or decrease in ED visits or hospitalizations for the following 6-month period. Successful asthma self-management includes multiple components, such as correct prescription and proper technique for using rescue and controller asthma medications, appropriate environmental management, and careful monitoring of asthma symptoms. The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend that clinicians teach patients essential components of self-management and integrate and reinforce patient education into every step of clinical care.2National Heart Lung and Blood Institute. Guidelines for the Diagnosis and Management of Asthma. NIH Publication No. 97-4051.Google Scholar The intervention described by Smith et al1Smith S.R. Jaffe D.M. Fisher E.B. Trinkaus K.M. Highstein G. Strunk R.C. Improving follow-up for children with asthma after an acute emergency department visit.J Pediatr. 2004; 145: 772-777Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar is innovative and adds to our understanding of how to improve post-ED asthma care. However, the study also highlights the importance and responsibility of primary care providers in helping sustain asthma educational efforts initiated in the ED or other settings. Asthma self-management education must be continually reinforced and tailored to the patient's needs. If primary care clinicians are not properly trained to educate families or incorporate NHLBI asthma guidelines into practice, it is unlikely that improved asthma outcomes will be sustained. Primary care provider education is an important component in implementing NHLBI recommendations. For example, in a randomized controlled trial involving 74 primary care providers and 637 of their patients, Clark et al3Clark N.M. Gong M. Schork M.A. Evans D. Roloff D. Hurwitz M. et al.Impact of education for physicians on patient outcomes.Peds. 1998; 101: 831-836Crossref Scopus (276) Google Scholar noted that among children who were placed on inhaled corticosteroids during the study period, those children treated by physicians who were trained in asthma education had significantly fewer symptoms and decreased asthma health care use. This finding suggests that the impact of appropriate prescription of antiinflammatory medications can be significantly enhanced with concurrent patient education from primary care providers.3Clark N.M. Gong M. Schork M.A. Evans D. Roloff D. Hurwitz M. et al.Impact of education for physicians on patient outcomes.Peds. 1998; 101: 831-836Crossref Scopus (276) Google Scholar Although the intervention described by Smith et al1Smith S.R. Jaffe D.M. Fisher E.B. Trinkaus K.M. Highstein G. Strunk R.C. Improving follow-up for children with asthma after an acute emergency department visit.J Pediatr. 2004; 145: 772-777Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar improved patient symptoms for only 15 days, the importance of post-ED follow-up visits should not be disregarded. Directly including primary care providers in post-ED care interventions may be necessary. As noted by the authors, “working with primary care providers to help them provide effective regular care” may help strengthen and sustain the post-ED interventions designed to improve overall asthma care. Improving follow-up for children with asthma after an acute Emergency Department visitThe Journal of PediatricsVol. 145Issue 6PreviewTo improve follow-up with primary care providers after acute Emergency Department (ED) asthma visits for children from low-income urban families. Full-Text PDF ReplyThe Journal of PediatricsVol. 147Issue 3PreviewTo the Editor: Full-Text PDF