Primary care visits for asthma monitoring over time and association with acute asthma visits for urban Medicaid-insured children.
Primary care visits for asthma monitoring over time and association with acute asthma visits for urban Medicaid-insured children.
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DOI：
10.3109/02770903.2014.927483
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发表时间：
2014-11
期刊：
影响因子：
--
通讯作者：
Strunk RC
中科院分区：
文献类型：
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作者：
Nelson KA;Garbutt JM;Wallendorf MJ;Trinkaus KM;Strunk RC
研究一段时间内因哮喘监测(AM)而前往初级保健提供者(PCP)就诊的次数与急诊科(ED)和医疗补助参保儿童的初级保健提供者(PCP)急性哮喘就诊之间的关系。我们前瞻性地登记了2-10岁的儿童在急诊室哮喘就诊期间。我们连续3年对每个受试者的住院记录和初级保健记录进行审计。我们排除了同样接受哮喘专科医生治疗的受试者。PCP AM访问是那些有文件建议讨论哮喘处理，但没有急性哮喘症状或发现的患者。PCP“急性哮喘”就诊是指那些有急性哮喘症状或发现的患者，无论他们接受何种治疗。急诊哮喘就诊是那些有记录的哮喘治疗患者。使用广义线性模型分析AM就诊次数与急诊急诊和急诊哮喘之间的关系。对103名受试者进行了分析。在这3年中，每名儿童的AM平均就诊次数为2.5±2.3(标准差)，范围为0-10。只有50%的受试者至少有1次PCP就诊，并有记录表明服用了哮喘控制药物。平均每名儿童哮喘就诊次数为3.2±2.8次，范围为1-18次。每名儿童急性哮喘平均就诊次数为0.7±1.6次，范围为0-11次。AM就诊次数增加与急诊次数增加(估计为0.088；95%可信区间为0.001，0.174)和急性哮喘就诊次数增加(估计为0.297；95%可信区间为0.166，0.429)相关。因任何诊断而增加初级保健医生就诊与急诊就诊无关(估计为0.021；95%CI−为0.018，0.06)。对于这些城市医疗补助保险的儿童，哮喘监测就诊和有记录的控制者药物治疗在3年内很少发生，哮喘监测就诊次数越多，急诊或PCP急性哮喘就诊次数越少。
To examine the association between numbers of primary care provider (PCP) visits for asthma monitoring (AM) over time and acute asthma visits in the emergency department (ED) and at the PCP for Medicaid-insured children. We prospectively enrolled children 2–10 years-old during ED asthma visits. We audited hospital and PCP records for each subject for 3 consecutive years. We excluded subjects also receiving care from asthma subspecialists. PCP AM visits were those with documentation that suggested discussion of asthma management but no acute asthma symptoms or findings. PCP “Acute Asthma” visits were those with documentation of acute asthma symptoms or findings, regardless of treatment. ED asthma visits were those with documented asthma treatment. Generalized liner models were used to analyze the association between numbers of AM visits and acute asthma visits to the ED and PCP. One hundred three subjects were analyzed. Over the 3 years, the mean number of AM visits/child was 2.5 ± 2.3 (standard deviation), range 0–10. Only 50% of subjects had at least 1 PCP visit with an asthma controller medication documented. The mean number of ED asthma visits/child was 3.2 ± 2.8; range 1–18. The mean number of PCP Acute Asthma visits/child was 0.7 ± 1.6; range 0–11. Increasing AM visits was associated with more ED visits (estimate 0.088; 95% CI 0.001, 0.174), and more PCP Acute Asthma visits (estimate 0.297; 95% CI 0.166, 0.429). Increasing PCP visits for any diagnosis was not associated with ED visits (estimate 0.021; 95% CI −0.018, 0.06). Asthma monitoring visits and documented controller medication for these urban Medicaid-insured children occurred infrequently over 3 years, and having more asthma monitoring visits was not associated with fewer ED or PCP acute asthma visits.
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影响因子：
1.4
作者：
Liberman, Danica B.;Shelef, Deborah Q.;Teach, Stephen J.
通讯作者：
Teach, Stephen J.
影响因子：
8
作者：
Akinbami, Lara J.;Moorman, Jeanne E.;Sondik, Edward J.
通讯作者：
Sondik, Edward J.
影响因子：
5.9
作者：
Eisner, MD;Ackerson, LM;Lieu, T
通讯作者：
Lieu, T
影响因子：
8
作者：
Fisher, EB;Strunk, RC;Walker, MS
通讯作者：
Walker, MS
影响因子：
14.2
作者：
通讯作者：
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