TY - JOUR
T1 - Asthma exacerbations in North American adults
T2 - Who are the "frequent fliers" in the emergency department?
AU - Griswold, Sharon K.
AU - Nordstrom, Carla R.
AU - Clark, Sunday
AU - Gaeta, Theodore J.
AU - Price, Michelle L.
AU - Camargo, Carlos A.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2005/5
Y1 - 2005/5
N2 - Objective: To characterize adult asthma patients according to frequency of emergency department (ED) visits in the past year. Design: Adults presenting with acute asthma to 83 US EDs underwent structured interviews in the ED and by telephone 2 weeks later. Results: The 3,151 enrolled patients were classified into four groups: those reporting no ED visits in the past year (27%), one to two visits (27%), three to five visits (25%), and six or more visits (21%). The number of ED visits (NEDV) was associated with older age, nonwhite race, lower socioeconomic status, and several markers of chronic asthma severity (all p < 0.001). NEDV was strongly associated with Medicaid insurance (17% among those with no visits, 22% with one to two visits, 30% with three to five visits, 39% with six or more visits; p < 0.001). NEDV was unrelated to gender or having a primary care provider (PCP). In a multivariate model, independent predictors of high ED use (six or more visits a year) were nonwhite race, Medicaid, other public, and no insurance, and markers of chronic asthma severity. Patients with six or more ED visits accounted for 67% of all prior ED visits in the past year. Conclusions: High NEDV is associated with characteristics that may help with identification of "frequent fliers" in the ED. A better understanding of these characteristics may advance ongoing efforts to decrease asthma health-care disparities, including differential access to primary asthma care. National guidelines recommend specific ED treatments then referral to a PCP. Although longitudinal care is surely important, attempts to reduce frequent ED asthma visits may be better directed toward more specific preventive and educational needs.
AB - Objective: To characterize adult asthma patients according to frequency of emergency department (ED) visits in the past year. Design: Adults presenting with acute asthma to 83 US EDs underwent structured interviews in the ED and by telephone 2 weeks later. Results: The 3,151 enrolled patients were classified into four groups: those reporting no ED visits in the past year (27%), one to two visits (27%), three to five visits (25%), and six or more visits (21%). The number of ED visits (NEDV) was associated with older age, nonwhite race, lower socioeconomic status, and several markers of chronic asthma severity (all p < 0.001). NEDV was strongly associated with Medicaid insurance (17% among those with no visits, 22% with one to two visits, 30% with three to five visits, 39% with six or more visits; p < 0.001). NEDV was unrelated to gender or having a primary care provider (PCP). In a multivariate model, independent predictors of high ED use (six or more visits a year) were nonwhite race, Medicaid, other public, and no insurance, and markers of chronic asthma severity. Patients with six or more ED visits accounted for 67% of all prior ED visits in the past year. Conclusions: High NEDV is associated with characteristics that may help with identification of "frequent fliers" in the ED. A better understanding of these characteristics may advance ongoing efforts to decrease asthma health-care disparities, including differential access to primary asthma care. National guidelines recommend specific ED treatments then referral to a PCP. Although longitudinal care is surely important, attempts to reduce frequent ED asthma visits may be better directed toward more specific preventive and educational needs.
UR - http://www.scopus.com/inward/record.url?scp=19844375420&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=19844375420&partnerID=8YFLogxK
U2 - 10.1378/chest.127.5.1579
DO - 10.1378/chest.127.5.1579
M3 - Article
C2 - 15888831
AN - SCOPUS:19844375420
VL - 127
SP - 1579
EP - 1586
JO - Chest
JF - Chest
SN - 0012-3692
IS - 5
ER -