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Pediatricians Support Initiation of Asthma Controller Medications in the Emergency Department: A National Survey
Esther M Sampayo1, Robert J McLoughlin, Despina Tsevdos
1From the *Section of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX; †University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ; and ‡Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine University of Pennsylvania, Philadelphia, PA.
Insights
Most pediatricians support emergency department initiation of asthma controller medications for children. Key considerations include communication with primary care physicians and appropriate severity assessment for effective asthma management.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Healthcare Policy
Background:
- National guidelines recommend emergency department (ED) initiation of controller medications for asthma.
- Current practice suggests this recommendation is infrequently implemented.
Purpose of the Study:
- To assess primary care pediatricians' (PCP) beliefs and attitudes towards ED initiation of controller medications for children with persistent asthma.
- To identify barriers and facilitators to this practice.
Main Methods:
- Cross-sectional mail survey of a national sample of pediatricians from the American Academy of Pediatrics.
- Survey included questions on beliefs, barriers, and support for guideline recommendations.
Main Results:
- 83% of PCPs found it appropriate for ED physicians to initiate controller medications for persistent asthma.
- 80% supported the guideline, but most reported infrequent prior experience with this practice.
- Key supporting beliefs included capturing lost patients and reinforcing medication use; barriers included ED time and PCP communication.
Conclusions:
- A majority of pediatricians support ED initiation of asthma controller medications.
- Effective implementation requires PCP communication, appropriate severity assessment, and patient education.
Objectives:
Although National Asthma Guidelines recommend that emergency department (ED) physicians consider initiating controller medications, research suggests that this practice occurs infrequently. The goal of this study was to assess primary care pediatricians' (PCP) beliefs and attitudes regarding ED initiation of controller medications for children with persistent asthma symptoms.
Methods:
This was a cross-sectional mail survey of a randomly selected national sample of pediatricians from the American Academy of Pediatrics. The survey posed questions regarding beliefs, barriers, and support for national guideline recommendations.
Results:
Eight hundred eighty-six (44.3%) of 2000 subjects responded. Five hundred seventy-two (64.5%) respondents met eligibility for analysis. When presented with a vignette of a child with persistent asthma, 476 (83%) of PCPs felt it was appropriate for the ED physician to initiate controller medications. Most (80%) PCPs supported the national guideline recommendation, although a similar proportion reported they have never or rarely experienced this practice before. Only 11% opposed the practice in all circumstances. Beliefs supporting this practice included the following: opportunity to capture patients lost to follow-up (85%), reinforcement of daily use of controller medications (83%), and controller medication may shorten an acute exacerbation (53%). Barriers included lack of time for education in ED (65%), reinforcement of ED use for primary care (64%), lack of PCP communication (62%), and inability to assess severity appropriately (41%). Most (90%) PCPs expect communication from the ED provider.
Conclusions:
A majority of pediatricians support the practice of ED physicians initiating controller medication during an acute visit for asthma. Communication with the PCP, appropriate screening of severity, and education about controller medications were important considerations expressed by these providers.
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