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Care of asthma: allergy clinic versus emergency room
C M Moore1, I Ahmed, R Mouallem
1Division of Allergy & Immunology, Louisiana State University Medical Center, New Orleans, USA.
Insights
Pediatric asthma patients using allergy clinics experience less severe symptoms and lower costs compared to those relying on emergency rooms. Specialized care in allergy clinics improves asthma outcomes for children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Healthcare Management
Background:
- Asthma affects inner-city pediatric populations, with significant morbidity and mortality.
- Many children with asthma utilize emergency rooms (ER) as their primary care, while some attend allergy-immunology clinics.
- Demographic and socioeconomic factors influence asthma care access and outcomes in urban children.
Purpose of the Study:
- To compare the demographic and socioeconomic characteristics of pediatric asthma patients using ER versus allergy-immunology clinics.
- To evaluate and compare the morbidity and cost of care between these two patient groups.
- To determine the impact of care setting on asthma management outcomes in children.
Main Methods:
- A comparative study involving 50 consecutive ER patients and 25 clinic patients with asthma.
- Utilized an identical questionnaire to collect data on demographic, socioeconomic, and clinical factors.
- Analyzed asthma severity, symptom frequency, healthcare utilization, and costs of care.
Main Results:
- No significant demographic or socioeconomic differences were found between ER and allergy clinic groups, except for age (ER: 7.8 years, Clinic: 10.6 years).
- Allergy clinic patients reported significantly less nocturnal cough, sleep interruption, weekly asthma symptoms, and fewer ER visits.
- Allergy clinic care was associated with an average annual cost saving of approximately $137 per patient, despite minor cost increases from a few complex cases.
Conclusions:
- Pediatric asthma patients attending allergy-immunology clinics and emergency rooms share similar demographic and socioeconomic profiles.
- Specialized care in allergy-immunology clinics is associated with reduced asthma morbidity and lower healthcare costs compared to emergency room-based care.
- The findings suggest that allergy-immunology clinics provide more effective asthma management for inner-city pediatric populations.
Background:
Demographic and socioeconomic factors have an impact upon the morbidity and mortality rates of asthma in inner-city pediatric populations. Many pediatric patients with asthma use the emergency room as their primary care physician, while a smaller number of children with asthma use the allergy-immunology clinic.
Objective:
We examined the demographic and socioeconomic characteristics of asthmatic patients using the emergency room as their primary care physician and of those attending the allergy-immunology clinic in the same inner-city hospital. We compared the morbidity and cost of care of asthmatic patients who received their medical care in the emergency room to that of those who received their care in the allergy-immunology clinic.
Methods:
Fifty consecutive emergency room patients and 25 clinic patients were studied using an identical questionnaire.
Results:
There was no difference between the two groups in the total number of individuals per household, children per family, monthly income, type or size of dwelling, financial problems purchasing medications, health insurance type, distance to the medical center, or education of the caretaker. Severity of asthma was not different in the two groups before the start of the study. The only significant demographic difference was in age: 10.6 years for the clinic group and 7.8 years for the emergency room group (P < .002). Clinically, in the year preceding the interview, the clinic group had significantly less nocturnal cough (P < .025), sleep interruption (P < .001), weekly asthma (P < .05), and emergency room visits (P < .09). The allergy clinic group had an approximate average savings of $137 per patient per year. Hospital admissions and emergency room costs were increased by a small group of three allergy clinic patients, decreasing the difference in the cost of care between the two groups.
Conclusion:
The data showed that patients who attended the emergency room and those who attended the allergy-immunology clinic were not demographically or socioeconomically different. The decreased morbidity of asthma and cost of care for the allergy clinic patients, as opposed to the emergency room patients, are likely due to the care given in the allergy-immunology clinic.