Reduction in Resource Utilization by an Asthma Outreach Program

Greineder, Dirk K.; Loane, Kathleen C.; Parks, Paula

doi:10.1001/archpedi.1995.02170160069010

Cited by 141 publications

(60 citation statements)

References 13 publications

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“…Entretanto, é pouco comum observar melhora brusca no curso da asma persistente, na ausência de intervenção profilática, sobretudo em casuística numerosa 5,19,20,25 . Por outro lado, as reduções encontradas de 80 e 86,7% nas frequências de hospitalização e dos atendimentos de urgência, respectivamente, concordam com diversos estudos.…”

Section: Discussionunclassified

Impact of an asthma management program on hospitalizations and emergency department visits

et al. 2011

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Objectives: To assess the frequency of hospitalizations and emergency department visits of children and adolescents before and after the enrolment in an asthma program.Methods: Medical records of 608 asthmatics younger than 15 years were assessed retrospectively. The frequency of hospitalizations and emergency department visits caused by exacerbations were evaluated before and after enrolment in an asthma program. Patients were treated with medications and a wide prophylactic management program based on the Global Initiative for Asthma (GINA). The before asthma program (BAP) period included 12 months before enrollment, whereas the after asthma program (AAP) period ranged from 12 to 56 months after enrollment. Results:In the BAP period, there were 895 hospitalizations and 5,375 emergency department visits, whereas in the AAP period, there were 180 and 713, respectively. This decrease was significant in all statistical analyses (p = 0.000). Conclusions:Compliance with the GINA recommendations led to a significant decrease in the frequency of hospitalizations and emergency department visits in children and adolescents with asthma.J Pediatr (Rio J). 2011;87(5):412-8: Asthma, hospitalisation, emergency medical services, continuing education, primary health care. ResumoObjetivo: Analisar as frequências de hospitalização e de atendimentos em serviços de urgência ocorridas em crianças e adolescentes antes e após o ingresso em programa de asma no Brasil. Métodos:Prontuários de 608 pacientes menores de 15 anos e com asma foram avaliados retrospectivamente. As frequências de hospitalização por asma e de atendimentos em serviços de urgência para episó-dios agudos de broncoespasmo foram avaliadas nos períodos anterior e posterior à admissão no programa que disponibiliza medicamentos, preconiza abordagem integral do paciente e manejo profilático de acordo com a Global Initiative for Asthma (GINA). O período de observação antes do programa (AP) teve a duração de 12 meses enquanto o depois do programa (DP) variou de 12 a 36 meses. Resultados:No período AP, ocorreram 895 hospitalizações e 5.375 atendimentos em serviços de urgência, e no período DP, ocorreram 180 hospitalizações e 713 atendimentos na urgência. O teste t de Student para amostras pareadas e o modelo de regressão para observações dependentes identificaram efeito significativo do programa em relação às variáveis estudadas (p = 0,000). Conclusões:A adoção das recomendações do GINA levou à redução significativa nas frequências de hospitalização e atendimentos na urgência em crianças e adolescentes com asma. J Pediatr (Rio J). 2011;87(5):412-8:Asma, hospitalização, atendimento de emergência, educação continuada, atenção básica à saúde. Impact of an asthma management program on hospitalizations and emergency department visitsImpacto de um programa de manejo da asma sobre as hospitalizações e os atendimentos de urgência IntroduçãoA asma, reconhecido problema de saúde pública, vem apresentando aumento na prevalência nas últimas décadas em algumas partes do mundo, ...

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Section: Discussionunclassified

Impact of an asthma management program on hospitalizations and emergency department visits

et al. 2011

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“…41 ' 53 There is also evidence that asthma education can reduce hospitalizations and emergency department (ED) visits. 54 ' 55 Several studies have shown that pharmacists can be particularly effective in improving asthma-related outcomes through patient education interventions. 56 " 58 Since the content of education programs has tended to vary, it will be important to identify the key elements of effective programs, which can then be broadly disseminated.…”

Section: Recommendation 2 Teach All Children With Persistent Asthma mentioning

confidence: 99%

Improving Childhood Asthma Outcomes in the United States: A Blueprint for Policy Action

et al. 2002

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Background/Objective. Asthma is increasingly being recognized as an important public health concern for children in the United States. Effective management of childhood asthma may require not only improving guideline-based therapeutic interventions, but also addressing social and physical environmental risk factors. The objective of this project was to create a blueprint for improvement of national policy in this area. Design/Methods. A nominal group process with nationally recognized experts and leaders (referred to as “the committee”) in childhood asthma. Results. The committee identified 11 policy recommendations (numbered in order below) in 2 broad categories: Improving Health Care Delivery and Financing, and Strengthening the Public Health Infrastructure. Recommendations regarding Improving Health Care Delivery and Financing include the development and implementation of quality-of-care standards in 1) primary care, 2) self-management education, and 3) case-management interventions, and the expansion of insurance coverage and benefit design by 4) extending continuous health insurance coverage for all children, 5) developing model insurance benefits packages for essential childhood asthma services, and 6) educating health care purchasers in how to use them. Recommendations for Strengthening the Public Health Infrastructure include public funding of asthma services that fall outside the insurance system through establishing 7) public health grants to foster asthma-friendly communities and 8) school-based asthma initiatives. 9) Launching a national asthma public education campaign, 10) developing a national asthma surveillance system, and 11) establishing a national agenda for asthma prevention research, with an emphasis on epidemiologic and behavioral sciences, are also recommended. Conclusions. Implementing these recommendations will require coordination of activities at the national, state, and local community level, and within and outside the health care delivery system. With a further commitment of national and local resources, implementation of these recommendations will likely lead to improved child and family asthma outcomes in the United States. childhood asthma, health care policy, health care services.

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“…Outreach by trained asthma nurses began in 1990 for children who were seen in the ED or hospitalized with asthma, and it was extended to the entire population by 1994. 36 Medicaid patients received special attention in these outreach efforts, which are continuing. It will be important to assess the impact of these programs over time, which are similar to those being undertaken by a number of managed care organizations.…”

Section: Commentmentioning

confidence: 99%

Comparing Asthma Care for Medicaid and Non-Medicaid Children in a Health Maintenance Organization

Finkelstein¹,

Barton²,

Donahue³

et al. 2000

Arch Pediatr Adolesc Med

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Objective: To compare ambulatory visit patterns, rates of medication use, and emergency department and hospital utilization for children with asthma covered under Medicaid and commercial payers within the same health maintenance organization (HMO).Design: Retrospective cohort study.Setting: Eleven staff-model pediatric departments of an HMO.Patients: A total of 1928 Medicaid and 11 007 nonMedicaid children aged 2 to 18 years with at least 1 encounter with a diagnosis of asthma between October 1, 1991, and September 30, 1996. Methods:We linked patient-level data from the HMO's automated medical record system for ambulatory encounters, a claims system for emergency department and hospital care, and an automated pharmacy dispensing database. Medicaid and non-Medicaid patients were compared for all encounter types and for prescribing and dispensing of ␤-agonist and controller medications (inhaled corticosteroids and cromolyn sodium). Incidence rate ratios were calculated from Poisson regression models to control for age, sex, and, when appropriate, ␤-agonist dispensing rate. The number of refills authorized on each prescription and the fraction of medications dispensed as refills compared with new prescriptions were compared for Medicaid and non-Medicaid patients.Results: Medicaid-insured children in the HMO were 1.4 times (95% confidence interval, 1.2-1.5) more likely to receive care in emergency departments and 1.3 times (95% confidence interval, 1.1-1.5) more likely to be hospitalized for their asthma compared with non-Medicaid members. Medicaid and non-Medicaid enrollees had similar yearly rates of nonurgent (1.32 vs 1.17) and urgent (0.38 vs 0.31) ambulatory visits. ␤-Agonists were dispensed roughly equally to Medicaid and non-Medicaid members. Although Medicaid patients were less likely to have controller medications dispensed (relative risk, 0.72; 95% confidence interval, 0.69-0.74), they were equally likely to have them prescribed.Conclusions: Differences in ambulatory contact for Medicaid members do not explain the higher rates of emergency department visits and hospitalization in this population. Reasons for lower rates of dispensing of controller medications should continue to be investigated as one cause of increased morbidity for low-income children with asthma.

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Reduction in Resource Utilization by an Asthma Outreach Program

Cited by 141 publications

References 13 publications

Impact of an asthma management program on hospitalizations and emergency department visits

Impact of an asthma management program on hospitalizations and emergency department visits

Improving Childhood Asthma Outcomes in the United States: A Blueprint for Policy Action

Comparing Asthma Care for Medicaid and Non-Medicaid Children in a Health Maintenance Organization

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