Follow-up Care Helps Prevent Repeat Asthma-Related Emergency Department Visits in Children and Young Adults

But researchers find that fewer than 1 in 4 children and young adults had follow-up visits.

According to the Centers for Disease Control and Prevention (CDC), asthma is the most common chronic lung disease in children. It affects about 6 million children in the United States and accounts for over 500,000 emergency department visits for children each year. Emergency care is associated with increased costs for families and health care systems as well as significant disruptions to children’s learning via missed school days.

Clinical practice guidelines for asthma management recommend that patients follow up with their primary care provider or asthma specialist within one to four weeks of visiting an emergency department for an asthma exacerbation. A study published in Academic Pediatrics in April showed that having follow-up care within two weeks of an asthma-related emergency department visit lowered the likelihood of future asthma-related emergency visits in children and young adults.

Naomi Bardach, M.D., of the University of California, San Francisco, and her colleagues looked at data from Medicaid claims in California and commercial insurance claims in Vermont and Massachusetts over one year. Participants were 3 to 21 years old and had visited an emergency department for an asthma-related event during the study year. The outcomes measured were revisits to the emergency department within 60 or 365 days of the initial visit.

In total, over 90,000 patients visited the emergency department for an asthma exacerbation. Of these, 23% followed up with a primary care provider or a specialist within 14 days of emergency treatment. Of the follow-ups, 71% were with a pediatrician, 17% with a family medicine physician, 9% with an internal medicine professional, and 3% with a pulmonologist or allergy specialist. Patients more likely to receive follow-up care were younger, had commercial insurance, had complex chronic conditions, and had a prior history of asthma.

The study found that patients who had a follow-up visit within 14 days of emergency care were less likely to revisit the emergency department within 60 days of the initial visit than those who had not received follow-up care (5.7% versus 6.4%). The researchers also saw long-term benefits of asthma follow-up care. Participants who received follow-up care within 14 days were less likely to return to the emergency department for an asthma-related event within the next year than patients who did not have a follow-up visit (25.0% versus 28.3%).

An asthma-related emergency department visit presents an opportunity to discover gaps in patient care or educational opportunities for patients and their families. A follow-up visit provides a platform to address these gaps and opportunities. Bardach and her colleagues commented: “An urgent emergency department visit for asthma may indicate a need for daily asthma medications, patient difficulty in recognizing asthma symptoms, difficulty managing asthma symptoms triggers, or any number of clinical issues. As a result, follow-up care for additional patient education, pharmacologic therapy, or environmental control could help decrease the likelihood of a repeat emergency department visit.”

Based on the low percentage of participants in this study who received follow-up care (23%), the authors see opportunities for improvements in emergency department discharge procedures, establishing relationships with primary care providers, and opening access to primary care.