Predictors of prior asthma specialist care among pediatric patients seen in the emergency department for asthma
Predictors of prior asthma specialist care among pediatric patients seen in the emergency department for asthma
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DOI：
10.1080/02770903.2018.1493600
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发表时间：
2019-08-03
影响因子：
1.9
通讯作者：
Okelo, Sande O.
中科院分区：
文献类型：
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作者：
Agnihotri, Neha T.;Pade, Kathryn H.;Okelo, Sande O.
背景：哮喘指南建议在急诊科(ED)就诊期间对哮喘预后不佳的患者进行专科护理。在寻求儿科哮喘护理的ED人群中，哮喘专家护理的流行率和预测因素尚不清楚。目的：根据父母关于既往哮喘发病率和哮喘护理的报告，在ED人群中检查与既往使用哮喘专科医生有关的因素。方法：对寻求急诊哮喘治疗的0-17岁儿童的父母进行社会人口学、哮喘发病率、哮喘管理和哮喘专科治疗现状的调查。我们比较了以前的哮喘护理和发病率，以及那些目前由哮喘专家护理的患者和没有哮喘专家护理的患者。预测哮喘专科医生使用相关因素的多变量Logistic回归模型根据父母教育程度和保险类型进行了调整。结果：在150名儿童(62%的男孩，平均年龄4.7岁，69%的西班牙裔)中，22%的儿童报告了哮喘专科治疗，75%的儿童没有看专科医生，3%的专科医生身份不明。那些没有看专家的人的护理更差，包括控制性药物的使用不足(24%对，p<；0.001)和哮喘行动计划(20%对62%，p<；0.001)。多变量Logistic回归显示，缺乏初级保健医生的建议降低了专科护理的几率(OR 0.01，95%CI
Background: Asthma guidelines recommend specialist care for patients experiencing poor asthma outcomes during emergency department (ED) visits. The prevalence and predictors of asthma specialist care among an ED population seeking pediatric asthma care are unknown. Objective: To examine, in an ED population, factors associated with prior asthma specialist use based on parental reports of prior asthma morbidity and asthma care. Methods: Parents of children ages 0 to 17 years seeking ED asthma care were surveyed regarding socio-demographics, asthma morbidity, asthma management and current asthma specialist care status. We compared prior asthma care and morbidity between those currently cared for by an asthma specialist versus not. Multivariable logistic regression models to predict factors associated with asthma specialist use were adjusted for parent education and insurance type. Results: Of 150 children (62% boys, mean age 4.7 years, 69% Hispanic), 22% reported asthma specialist care, 75% did not see a specialist and for 3% specialist status was unknown. Care was worse for those not seeing a specialist, including under-use of controller medications (24% vs. 64%, p < 0.001) and asthma action plans (20% vs. 62%, p < 0.001). Multivariable logistic regression revealed that lack of recommendation by the primary care physician reduced the odds of specialist care (OR 0.01, 95% CI