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Only a third of children with asthma treated in an Ontario ED seek recommended follow-up care

September 6, 2012 Toronto

Most children with asthma who were treated for an asthma attack in an Ontario emergency department (ED) did not access the recommended follow-up care, according to new research from the Institute for Clinical Evaluative Sciences (ICES).

“Asthma is a chronic disease that requires good follow-up care after children have had an acute attack requiring emergency department care to ensure that they have an appropriate ongoing management plan,” says senior author Dr. Astrid Guttmann, a senior scientist with ICES and a paediatrician at The Hospital for Sick Children (SickKids).

Asthma is the most common cause for hospital admission in Canadian children, but these hospitalizations are considered largely preventable with good outpatient care. In earlier studies it was shown that about 1 in 10 Ontario children with asthma had an ED visit during a two-year period. In Michigan, for example, 30 per cent of children with asthma reported using the ED for urgent asthma care despite the fact that 90 per cent of them had a primary care provider.

However, another relapse that requires ED care or hospitalization for children with asthma is not guarenteed because there was follow-up visit. The researchers say this shows there are no easy fixes to chronic disease management and stress the lack of association doesn't negate the recommendations for early follow-up but rather a need to focus on the quality and continuity of outpatient care and the need to target high risk children for more intensive review of their asthma care.

The population-based retrospective cohort study of children with asthma aged 2–17 years treated in an ED and sent home in Ontario between 2006 and 2009 found that:

  • Few children (32.8 per cent) completed the recommended follow-up visit with a physician within 28 days.
  • Almost a quarter (22 per cent) of these children relapsed and need to go to an ED, and 3 per cent had a hospital admission in the subsequent year.
  • Having a follow-up visit with a physician within 28 days does not seem to protect from relapse needing ED or hospital care.

“Both the low rates of follow-up and the lack of improved long-term outcomes for those who did follow-up illustrate how complex it is to ensure that children with asthma maintain good disease control,” says Dr. Patricia Li, the lead author and a paediatrician at McGill University and the Montreal Children’s Hospital.

Authors: Li P., To T., Guttmann A.

The study “Follow-up care after an emergency department visit for asthma and subsequent healthcare utilization in a universal-access healthcare system,” is in the current issue of the Journal of Pediatrics.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

The Hospital for Sick Children (SickKids) is recognized as one of the world's foremost paediatric health-care institutions and is Canada's leading centre dedicated to advancing children's health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada's most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision for Healthier Children. A Better World. For more information, please visit www.sickkids.ca

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