Randomized controlled trial of emergency department interventions to improve primary care follow-up for patients with acute asthma
Randomized controlled trial of emergency department interventions to improve primary care follow-up for patients with acute asthma
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DOI：
10.1378/chest.129.2.257
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发表时间：
2006-02-01
期刊：
影响因子：
9.6
通讯作者：
Camargo, CA
中科院分区：
文献类型：
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作者：
Baren, JM;Boudreaux, ED;Camargo, CA
目的：哮喘急诊（艾德）就诊频繁，可能表明发病率增加和初级保健可及性差。我们的目的是比较两种干预措施的效果。哮喘急性发作艾德治疗后的初级保健随访。方法：我们进行了一项随机对照试验的患者2至54岁，谁被判定为安全出院接受泼尼松，谁可在2天和30天的接触。如果患者之前入组或不会说英语，则将其排除。患者接受常规出院护理（A组）;免费泼尼松、往返于初级保健访视的交通券，以及电话提醒安排访视（B组）;或事先预约（C组）。主要结果是在30天内与哮喘初级保健提供者进行随访。次要结果是复发性艾德访视，随后的住院，生活质量，和使用吸入性皮质类固醇1 year later.Results：384例患者入组。基线人口统计学、慢性哮喘严重程度和获得护理的机会在各组之间相似。C组（65%）的初级保健随访率高于A组（42%）或B组（48%）[p = 0.002]。C组干预仍显着（比值比，2.8; 95%置信区间，1.5至5.1）时，调整其他因素影响随访（先前的初级保健关系，保险状态）。艾德，住院，生活质量，或吸入性皮质类固醇使用指数艾德visit.Conclusion后1年没有差异：干预措施，包括免费药物，交通券，预约援助显着增加的可能性，出院哮喘患者获得初级保健随访，但不影响长期结果。
Objective: Emergency department (ED) visits for asthma are frequent and may indicate increased morbidity and poor primary care access. Our objective was to compare the effect of two interventions on. primary care follow-up after ED treatment for asthma exacerbations.Methods: We performed a randomized controlled trial of patients 2 to 54 years old who were judged safe for discharge receiving prednisone, and who were available for contact at 2 days and 30 days. Patients were excluded if they were previously enrolled or did not speak English. Patients received usual discharge care (group A); free prednisone, vouchers for transport to and from a primary care visit, and either a telephone reminder to schedule a visit (group B); or a prior scheduled appointment (group C). Follow-up with a primary care provider for asthma within 30 days was the main outcome. Secondary outcomes were recurrent ED visits, subsequent hospitalizations, quality of life, and use of inhaled corticosteroids 1 year later.Results: Three hundred eighty-four patients were enrolled. Baseline demographics, chronic asthma severity, and access to care were similar across groups. Primary care follow-up was higher in group C (65%) vs group A (42%) or group B (48%) [p = 0.002]. Group C intervention remained significant (odds ratio, 2.8; 95% confidence interval, 1.5 to 5.1) when adjusted for other factors influencing follow-up (prior primary care relationship, insurance status). There were no differences in ED, hospitalizations, quality of life, or inhaled corticosteroid use at 1 year after the index ED visit.Conclusion: An intervention including free medication, transportation vouchers, and appointment assistance significantly increased the likelihood that discharged asthma patients obtained primary care follow-up but did not impact long-term outcomes.