Improving preventive care in high risk children with asthma: lessons learned

Area of Science:

• Pediatric Pulmonology
• Public Health
• Health Services Research

Background:

• Preventive asthma care rates are low for inner-city children post-emergency department (ED) visit.
• Frequent ED utilization signifies high morbidity in this population.

Purpose of the Study:

• To evaluate a clinician and caregiver feedback intervention's efficacy in enhancing preventive asthma care.
• To compare the intervention group (INT) against an attention control group (CON) for improving care post-ED visit.

Main Methods:

• 300 children with persistent asthma and recent ED visits were randomized into INT or CON groups.
• Follow-up was for 12 months, including nurse visits, interviews, salivary cotinine, and pharmacy records.
• Logistic regression analyzed differences in achieving two or more primary care provider (PCP) preventive visits within 12 months.

Main Results:

• The intervention group showed no significant increase in PCP visits or asthma action plan (AAP) adoption compared to controls.
• Children with an AAP at baseline were nearly twice as likely to have ≥2 PCP visits over 12 months.
• Baseline characteristics included predominantly young, African American, Medicaid-insured males with high mean ED visit rates.

Conclusions:

• The feedback intervention failed to improve preventive asthma care rates compared to the control group.
• Developing effective interventions to reduce morbidity in high-risk, inner-city children with frequent ED use requires further investigation.