Impact of Inhaled Antiinflammatory Therapy on Hospitalization and Emergency Department Visits for Children With Asthma

Adams, Robert; Fuhlbrigge, Anne L.; Finkelstein, Jonathan A.; Lozano, Paula; Livingston, James M.; Weiss, Kevin B.; Weiss, Scott T.

doi:10.1542/peds.107.4.706

Cited by 174 publications

(121 citation statements)

References 25 publications

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“…Earlier work has shown that hospital admissions and emergency department visits account for a substantial proportion of healthcare costs [33]. In the present study there were no hospitalisations or visits to the emergency department room for acute severe asthma, confirming that with the appropriate control of asthma, morbidity, hospitalisation and emergency department visits can be reduced [17,18]. For other populations with less optimal control the cost analysis may be less favourable.…”

Section: Discussionsupporting

confidence: 73%

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Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Kamps¹,

Roorda²,

Kimpen³

et al. 2004

Eur Respir J

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The high burden of asthma on healthcare utilisation and costs warrants economic appraisal of management approaches. The authors previously demonstrated that the efficacy of nurse-led outpatient management of childhood asthma was comparable to management by a paediatrician and now report on the healthcare utilisation and costs of both management approaches.A total of 74 newly referred children with asthma were randomly assigned to a 1-yr follow-up by paediatricians or asthma nurse. Healthcare utilisation was recorded and associated costs calculated for both management approaches.There were no significant differences in healthcare utilisation except for the total time spent on patient contact (136(n=14) versus 187(n=41) min, for patients followed-up by paediatrician and an asthma nurse repectively). Costs within the healthcare sector were reduced by 7.2% in favour of nurse-led care. The reduction in costs was solely attributable to a 17.5% reduction in the costs of outpatient visits. Nurse-led care appeared to be cost-saving even if the duration of follow-up visits would be twice that of doctor9s visits. Overall healthcare costs (within and outside the healthcare sector) were 4.1% lower for nurse-led outpatient management compared to traditional medical care.Nurse-led outpatient management of childhood asthma can be provided at a lower cost than medical care by paediatricians.

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Section: Discussionsupporting

confidence: 73%

“…In previous studies, it was shown that a reduction in healthcare utilisation, such as emergency department visits and hospitalisations, can be achieved with adequate asthma control [17,18]. Furthermore, maintenance treatment with inhaled corticosteroids has been shown to be cost effective [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Kamps¹,

Roorda²,

Kimpen³

et al. 2004

Eur Respir J

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“…Entretanto, a baixa adesão ao tratamento com esses medicamentos tem sido associada à elevada freqüência de hospitalizações e atendimentos em serviços de pronto-socorro 3 .…”

Section: Introductionunclassified

Compliance with inhaled corticosteroid treatment: rates reported by guardians and measured by the pharmacy

Lasmar

Camargos²,

Costa³

et al. 2007

J Pediatr (Rio J)

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Objetivo: A morbidade associada à asma é elevada, principalmente nos países em desenvolvimento, e as falhas na adesão ao uso de corticóide inalatório contribuem para esta elevação. Este estudo objetiva comparar as taxas de adesão ao uso de beclometasona relatadas pelos responsáveis e as mensuradas pelos registros de dispensação farmacêutica do medicamento. Métodos:Foi realizado um estudo de coorte concorrente com duração de 12 meses, do qual participaram 106 crianças e adolescentes asmáticos, selecionados aleatoriamente. Através da regressão linear, as taxas de adesão relatadas pelos responsáveis e pelos registros de dispensação da farmácia do serviço foram correlacionadas, quadrimestralmente, a partir da admissão no estudo.Resultados: As taxas de adesão relatadas pelos pais e/ou responsáveis foram sempre superiores (p < 0,001) e apresentaram fraca correlação com aquelas mensuradas pelos registros de farmácia nos períodos estudados, quarto (r = 0,37) e 12º (r = 0,31) mês do seguimento. Conclusão:As taxas de adesão relatadas pelos pais foram superestimadas em todos os períodos do estudo. Crianças com asma deveriam ter suas taxas de adesão também monitoradas por outros métodos e, neste caso, os registros de farmácia foram efetivos em revelar as falhas na adesão. Dado ao seu baixo custo, esse método está indicado para a verificação dessas taxas.J Pediatr (Rio J). 2007;83(5):471-476:Asma, adesão, corticóide inalatório, beclometasona.Objective: There is elevated morbidity associated with asthma, particularly in developing countries, and failure to comply with inhaled corticosteroid treatment contributes to this morbidity. The objective of this study is to compare rates of compliance with beclomethasone treatment reported by parents or guardians with those measured by pharmacy dispensing records. Methods:A concurrent cohort study of 12 months' duration was carried out, enrolling 106 asthmatic children and adolescents, selected at random. Linear regression was used to compare rates of compliance reported by parents or guardians with the pharmacy dispensing records at the service, every 4 months after enrollment on the study. Results:Compliance rates reported by parents and/or guardians were always higher (p < 0.001) and exhibited a weak correlation with pharmacy records during the period studied; fourth (r = 0.37) and twelfth (r = 0.31) months of follow-up. Conclusions:The rates of compliance reported by parents were overestimated during all study periods. The compliance rates of children with asthma should also be monitored by other methods and, in this case, pharmacy records effectively revealed compliance failures. Given its low cost, this method is indicated for verification of these compliance rates. Artigo submetido em 08.05.07, aceito em 11.07.07. J Pediatr (Rio J)

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“…5,7 Acknowledging the high rates of acute care visits for asthma, the Institute of Medicine has identifi ed asthma as an ambulatory care-sensitive condition. …”

Section: Introductionmentioning

confidence: 99%

“…1,4 Asthma is one of the most common reasons for hospital admission among children. 1,5 Appropriate use of controller medications can reduce asthma exacerbations, acute care visits for asthma, and hospitalizations.…”

Section: Introductionmentioning

confidence: 99%

Under-Utilization of Controller Medications and Poor Follow-Up Rates Among Hospitalized Asthma Patients

Lintzenich

Teufel

Basco

2011

Hospital Pediatrics

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OBJECTIVE: Recommended preventive care following an asthma admission includes prescribing controller medications and encouraging outpatient follow-up. We sought to determine (1) the proportion of patients who receive controller medications or attend follow-up after asthma admission and (2) what factors predict these outcomes. METHODS: South Carolina Medicaid data from 2007-2009 were analyzed.Patients who were included were 2 to 18 years old, and had at least one admission for asthma. Variables examined were: age, gender, race, and rural location. Outcome variables were controller medication prescription and follow-up appointment. Any claim for an inhaled corticosteroid (ICS) or ICS/long-acting beta-agonist in the 2 months after admission was considered appropriate. Any outpatient visit for asthma in the 2 months after admission was considered appropriate. Bivariate analyses used chi-square tests. Logistic regression models identifi ed factors that predict controller medications and follow-up. RESULTS:Five hundred fi ve patients were included, of whom 60% were male, 79% minority race/ethnicity, and 58% urban. Rates of receiving controller medications and attending follow-up appointments were low, and an even lower proportion received both. Overall, 52% received a controller medication, 49% attended follow-up, and 32% had both. Multivariable analyses demonstrated that patients not of minority race or ethnicity were more likely to receive controller medications (odds ratio, 1.7; 95% confi dence interval, 1.1-2.6). CONCLUSIONS:Patients with asthma admitted for acute exacerbations in South Carolina have low rates of controller medication initiation and followup attendance. Minority race/ethnicity patients are less likely to receive controller medications. To decrease rates of future exacerbations, inpatient providers must improve the rates of preventive care delivery in the acute care setting with a focus on racial/ethnic minority populations. IntroductionAsthma is the most prevalent chronic condition affecting children.1,2 The prevalence of asthma continues to increase. 1,3 In addition, morbidity and mortality associated with asthma continues to increase, including the number of hospitalizations, missed school days, and missed parental work days. 1,4 Asthma is one of the most common reasons for hospital admission among children.1,5 Appropriate use of controller medications can reduce asthma exacerbations, acute care visits for asthma, and hospitalizations. 5,7 Acknowledging the high rates of acute care visits for asthma, the Institute of Medicine has identifi ed asthma as an ambulatory care-sensitive condition. AN OFFICIAL JOURNAL OF THE AMERICAN ACADEMY OF PEDIATRICSDespite this, current evidence suggests that pediatric asthma patients underutilize preventive care in the ambulatory setting, including controller medications. [9][10][11][12] Asthma patients who are admitted to the hospital for acute exacerbations are at higher risk for future exacerbations 13,14 ; therefore, it is paramount that these patie...

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Impact of Inhaled Antiinflammatory Therapy on Hospitalization and Emergency Department Visits for Children With Asthma

Cited by 174 publications

References 25 publications

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Compliance with inhaled corticosteroid treatment: rates reported by guardians and measured by the pharmacy

Under-Utilization of Controller Medications and Poor Follow-Up Rates Among Hospitalized Asthma Patients

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