Follow-up prevents repeat ED visits for kids

Follow-up care after an asthma-related emergency room (ED) visit may help prevent future emergency room visits for children, according to a new study led by UC San Francisco researchers.

Previous studies examining the relationship between asthma-related ED visits and follow-up found either no protective effect, or that follow-up was paradoxically associated with increased ED use, possibly because sicker patients in ED were more likely to require follow-up. -up but were also more likely to have severe asthma and subsequent visits, the researchers said.

If there were follow-up for all visits, about 72,000 subsequent ED visits could be avoided and millions of dollars saved, the researchers said.

In the current study, patients 3 to 21 years old who received follow-up care within two weeks of an asthma-related ED visit were 12% less likely to return to the ED for asthma within 60 days, and 13% less likely to go back to the emergency room. for asthma in the following year.

The article is published online by Academic Pediatrics.

Only 23% of patients in the current study received follow-up care, although clinical practice guidelines recommend that all patients be referred for follow-up within one month of an ED visit for asthma. The patients who received it were younger and more likely to have commercial insurance, complex chronic conditions, and known asthma from previous ED visits.

“An urgent visit to the ED for asthma may indicate that the child needs daily asthma medication to better control their asthma, or that they are having difficulty avoiding asthma triggers or recognizing symptoms,” says Naomi Bardach , MD, a UCSF professor of pediatrics and lead author of the paper. study. “Follow-up visits are an opportunity to educate the family and child about managing their asthma, prescribe new medications if necessary, and ensure they are receiving the prescribed medications.”

Over 500,000 pediatric ED visits for asthma per year

Asthma is the most common chronic disease in children, affecting 9% of school-aged children and contributing to more than 500,000 ED visits for children each year, according to the CDC.

The researchers used claim data from California, Massachusetts and Vermont to identify asthma-related emergency room visits. Patients were most often followed up by a pediatrician (71%) followed by a general practitioner (17%), a general internist (9%) and a pulmonologist or immunologist (3%).

Approximately 5.7% of those with follow-up had a recurrent asthma-related ED visit within 60 days, compared with 6.4% who had no follow-up (p<0.001). After 365 days, 25% of those with follow-up had a second ED visit compared to 28.3% who had no follow-up.

Current research findings of a protective effect of follow-up may reflect changes in primary care asthma treatment, leading to more effective asthma control. Such changes likely include a step-by-step approach to the use of daily medications and better compliance by health care providers with recommendations to prescribe daily inhaler medications to patients with persistent asthma, the authors wrote.

“Follow-up care is a team effort between emergency room physicians, primary care physicians and families. The protective effect of the next visit after 14 days — even a year out — suggests that part of what is helpful is an existing and trusting relationship with a physician,” said bardach. “Primary care and emergency room clinicians can support families by helping establish and maintain primary care connections.”

Authors: UCSF co-authors are Charles McCulloch, PhD, of the Department of Epidemiology and Biostatistics, and Robert Thombley of the Department of Medicine. Additional authors and affiliations can be found in the newspaper.

Financing: The study was funded by the Agency for Research and Quality in Healthcare [U18HS025297 and U18HS020518]†

About UCSF: The University of California, San Francisco (UCSF) focuses solely on the health sciences and is committed to advancing health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. Serving as UCSF’s primary academic medical center, UCSF Health includes leading specialty hospitals and other clinical programs, and has affiliates throughout the Bay Area. Learn more at, or view our factsheet.

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Academic Pediatrics

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