A randomized, controlled trial of a simple emergency department intervention to improve the rate of primary care follow-up for patients with acute asthma exacerbations
A randomized, controlled trial of a simple emergency department intervention to improve the rate of primary care follow-up for patients with acute asthma exacerbations
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DOI：
10.1067/mem.2001.116593
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发表时间：
2001-08-01
影响因子：
6.2
通讯作者：
Hollander, JE
中科院分区：
文献类型：
--
作者：
Baren, JM;Shofer, FS;Hollander, JE
研究目的：我们确定一个简单的急诊科干预是否能提高急诊室出院后急诊服务提供者(PCP)对急性哮喘患者进行随访的可能性。方法：这项随机对照临床试验在城市大学的急诊室进行。参与者是年龄在16岁至45岁之间的哮喘患者，他们接受了治疗，并从急诊室出院。研究干预是常规护理或干预，包括免费的5天强的松疗程，往返PCF的交通券，以及48小时电话提醒与他们的PCP预约。结果：192例哮喘患者入选8个月以上，178例(93%)获得完全随访。干预组和对照组在年龄、性别、种族或受教育年限方面相似。两组在基线获取/护理障碍和ED恶化严重程度的多项测量方面也具有可比性。接受干预的患者比对照组患者更有可能随访PCP(相对风险1.6；95%可信区间[CI]1.1，24)。在调整了其他影响PCP随访护理的因素(种族、既往PCP关系、保险状况、定期用车)后，干预患者更有可能对其PCP进行随访(优势比3.1，-95%CI 1.5，6.3)。结论：提供药物、交通券和电话提醒预约增加了哮喘患者出院后获得PCP随访的可能性。
Study objective: We determined whether a simple emergency department intervention improves the likelihood of primary care provider (PCP) follow-up after ED discharge for an acute asthma exacerbation.Methods: This randomized, controlled clinical trial was conducted in an urban university-based ED. Participants were patients with asthma between the ages of 16 and 45 years who were treated and discharged from the ED. The study intervention was usual care or an intervention that consisted of a free 5-day course of prednisone, vouchers for transportation to and from their PCF, and a 48-hour telephone reminder to make an appointment with their PCP. The main outcome was whether the patient received follow-up care as determined by PCP contact at 4 weeks.Results: One hundred ninety-two patients with asthma were enrolled over 8 months; 178 (93%) had complete follow-up. The intervention and control groups were similar with regard to age, sex, ethnicity, or years of education. The 2 groups were also comparable with respect to multiple measures of baseline access/barriers to care and severity of ED exacerbation. Patients receiving the intervention were significantly more likely to follow up with their PCP than control patients (relative risk 1.6; 95% confidence interval [Cl] 1.1, 24). When adjusted for other factors influencing PCP follow-up care (ethnicity, prior PCP relationship, insurance status, regular car access), intervention patients were more likely to follow up with their PCP (odds ratio 3.1,- 95% Cl 1.5, 6.3).Conclusion: Providing medication, transportation vouchers, and a telephone reminder to make an appointment increased the likelihood that discharged patients with asthma obtained PCP follow-up.