Follow-up care prevents future visits to emergency department: Study

According to a new study, follow-up care after an asthma-related visit to the emergency department may help prevent future visits for children.

The study was published in the journal, 'Academic Pediatrics'.

Past studies on the relationship between asthma-related visits to the emergency department and follow-up found either no protective effect or that follow-up was paradoxically associated with increased use of the emergency department, possibly because sicker patients in the emergency department were more likely to get follow-up but were also more likely to have severe asthma and subsequent visits, the researchers said.

If follow-up were in place for all visits, around 72,000 subsequent revisits to the emergency department could be prevented and millions of dollars could be saved, the researchers said.

In the current study, patients 3 to 21 years old who received follow-up care within two weeks of an asthma-related visit to the emergency department were 12 per cent less likely to return to the emergency department for asthma within 60 days, and 13 per cent less likely to revisit for asthma in the next year.

Only 23 per cent of patients in the current study received follow-up care, although clinical practice guidelines recommend all patients be referred for follow-up within a month after an emergency department visit for asthma. The patients who received it were younger and more likely to have commercial insurance, complex chronic conditions, and known asthma from prior visits to the emergency department.

"An urgent emergency department visit for asthma may suggest the child needs daily asthma medications to better control their asthma, or that they are having difficulty avoiding asthma triggers or recognizing symptoms," said Naomi Bardach, MD, a UCSF pediatrics professor and lead author of the study.

"Follow-up visits are an opportunity to educate the family and child on managing their asthma, prescribe new medications if needed, and ensure success in getting prescribed medications," she added.

Asthma is the most common pediatric chronic disease, affecting 9 per cent of school-aged children, and contributing to over 500,000 visits to the emergency department for children annually, according to the CDC.

The researchers used claims data from California, Massachusetts, and Vermont to identify asthma-related emergency department visits. Patients were most likely to follow up with a paediatrician (71 per cent) followed by a family medicine physician (17 per cent), a general internist (9 per cent), and a pulmonologist or immunologist (3 per cent).

About 5.7 per cent of those with follow-up had a return asthma-related emergency department visit within 60 days, compared to 6.4 per cent who didn't have follow-up (p<0.001). At 365 days, 25 per cent of those with follow-up had a return emergency department visit compared to 28.3 per cent who had no follow-up.

The current study findings of a protective effect from follow-up may reflect changes in primary care management of asthma, which has led to more effective asthma control. Such changes likely include a stepwise approach to using daily medications and better provider adherence to recommendations to prescribe daily inhaler medication for patients with persistent asthma, the authors wrote.

"Follow-up care is a team effort between emergency department clinicians, primary care clinicians, and families. The protective effect of the following visit at 14 days -- even a year out -- suggests that part of what is helpful is having an existing and trusting relationship with a clinician," Bardach said.

"Primary care and emergency department clinicians can support families by helping establish and maintain primary care connections," Bardach concluded.