Impacto de una Red Interdisciplinaria de Atención para el Asma en las Visitas a Urgencias y las Hospitalizaciones

Current national and international asthma clinical practice guidelines emphasize care continuity and adherence to guideline-based care delivered through interdisciplinary teams. However, the efficacy of such teams in reducing urgent asthma-related care has not yet been assessed.

To measure the impact of an interdisciplinary asthma care network (ACN) on health services utilization.

We identified a retrospective cohort of individuals with confirmed or suspected asthma who received specialized interdisciplinary asthma care in Southeastern Ontario, Canada between 2009-2018. Individuals were matched (on age, sex, and year of asthma diagnosis) to controls with suspected asthma who were not enrolled in the ACN. Asthma-related emergency department (ED) and inpatient visits were compared via zero inflated Poisson regression, stratified between pediatric and adults.

1248 ACN patients were matched to 3629 non-ACN controls. Asthma-related ED visits were reduced for 21% of ACN patients versus 6.7% of non-ACN participants. Similarly, hospitalizations were reduced for 10.7% of ACN participants post-index visit compared to 1.4% of non-ACN participants (both P<0.001). Despite higher pre-enrolment health service utilization, ACN adults no longer had higher health service use compared to non-ACN, after enrolment in the network (Risk Ratio: 1.3 (0.9-1.88)). Pediatric ACN patients continued to have higher health service use compared to non-ACN participants post-enrolment (Risk Ratio 1.72 (1.30-2.26)).

Enrolment in a guideline-based interdisciplinary ACN reduces acute, unplanned asthma-related health service utilization, particularly in adults. Despite higher pre-enrolment health service utilization, adults enrolled in guideline-based interdisciplinary asthma care no longer had higher service use following enrolment.