Risk factors for recurrent emergency department visits for asthma
BACKGROUND--Patients presenting with asthma to emergency departments have lost control of their disease, have significant airways obstruction, and frequently require admission to hospital. Although even one visit is not desirable, there is a more disturbing subgroup who repeatedly visit the emergenc...
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Veröffentlicht in: | Thorax 1995-05, Vol.50 (5), p.520-524 |
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description | BACKGROUND--Patients presenting with asthma to emergency departments have lost control of their disease, have significant airways obstruction, and frequently require admission to hospital. Although even one visit is not desirable, there is a more disturbing subgroup who repeatedly visit the emergency department. METHODS--To investigate the reasons for multiple emergency visits, a questionnaire was given to 448 consecutive patients presenting to the two largest adult emergency departments in Ottawa, Canada between November 1989 and April 1991. Within this cohort, those who had made at least three visits in the past year were compared with controls (only one visit in the past year). RESULTS--Although inhaled corticosteroid use increased with multiple visits (indicating increased asthma severity), only 60% of those visiting at least three times in the past year were taking inhaled corticosteroids. Chronic undermedication relative to disease severity was apparent among the cases. The number of visits was associated with nocturnal asthma on a regular basis, work and school absenteeism, frequent visits to their regular physician, and frequent admissions to hospital. Visits were not related to psychological health, environmental allergens/irritants, or lack of perceived asthma severity. CONCLUSIONS--The recommendations of current asthma guidelines are not reaching these patients. The issue of translating guidelines from paper to practice must be addressed before highly effective medications can have an important impact on the frequency of emergency department visits. |
doi_str_mv | 10.1136/thx.50.5.520 |
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Although even one visit is not desirable, there is a more disturbing subgroup who repeatedly visit the emergency department. METHODS--To investigate the reasons for multiple emergency visits, a questionnaire was given to 448 consecutive patients presenting to the two largest adult emergency departments in Ottawa, Canada between November 1989 and April 1991. Within this cohort, those who had made at least three visits in the past year were compared with controls (only one visit in the past year). RESULTS--Although inhaled corticosteroid use increased with multiple visits (indicating increased asthma severity), only 60% of those visiting at least three times in the past year were taking inhaled corticosteroids. Chronic undermedication relative to disease severity was apparent among the cases. The number of visits was associated with nocturnal asthma on a regular basis, work and school absenteeism, frequent visits to their regular physician, and frequent admissions to hospital. Visits were not related to psychological health, environmental allergens/irritants, or lack of perceived asthma severity. CONCLUSIONS--The recommendations of current asthma guidelines are not reaching these patients. The issue of translating guidelines from paper to practice must be addressed before highly effective medications can have an important impact on the frequency of emergency department visits.</description><identifier>ISSN: 0040-6376</identifier><identifier>EISSN: 1468-3296</identifier><identifier>DOI: 10.1136/thx.50.5.520</identifier><identifier>PMID: 7597665</identifier><identifier>CODEN: THORA7</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Thoracic Society</publisher><subject>Adrenal Cortex Hormones - administration & dosage ; Adult ; Asthma - drug therapy ; Asthma - psychology ; Asthma - therapy ; Biological and medical sciences ; Canada ; Chronic obstructive pulmonary disease, asthma ; Cohort Studies ; Emergency Service, Hospital - statistics & numerical data ; Female ; Health Services Misuse ; Hospitalization ; Humans ; Male ; Medical sciences ; Morbidity ; Pneumology ; Risk Factors ; Treatment Failure</subject><ispartof>Thorax, 1995-05, Vol.50 (5), p.520-524</ispartof><rights>1995 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b478t-76e44a56c3fdf93cad826a9f5f5d97d6c7820b5cbd369a6463bcda0e47dc69de3</citedby><cites>FETCH-LOGICAL-b478t-76e44a56c3fdf93cad826a9f5f5d97d6c7820b5cbd369a6463bcda0e47dc69de3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1021222/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1021222/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3560661$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7597665$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dales, R E</creatorcontrib><creatorcontrib>Schweitzer, I</creatorcontrib><creatorcontrib>Kerr, P</creatorcontrib><creatorcontrib>Gougeon, L</creatorcontrib><creatorcontrib>Rivington, R</creatorcontrib><creatorcontrib>Draper, J</creatorcontrib><title>Risk factors for recurrent emergency department visits for asthma</title><title>Thorax</title><addtitle>Thorax</addtitle><description>BACKGROUND--Patients presenting with asthma to emergency departments have lost control of their disease, have significant airways obstruction, and frequently require admission to hospital. Although even one visit is not desirable, there is a more disturbing subgroup who repeatedly visit the emergency department. METHODS--To investigate the reasons for multiple emergency visits, a questionnaire was given to 448 consecutive patients presenting to the two largest adult emergency departments in Ottawa, Canada between November 1989 and April 1991. Within this cohort, those who had made at least three visits in the past year were compared with controls (only one visit in the past year). RESULTS--Although inhaled corticosteroid use increased with multiple visits (indicating increased asthma severity), only 60% of those visiting at least three times in the past year were taking inhaled corticosteroids. Chronic undermedication relative to disease severity was apparent among the cases. The number of visits was associated with nocturnal asthma on a regular basis, work and school absenteeism, frequent visits to their regular physician, and frequent admissions to hospital. Visits were not related to psychological health, environmental allergens/irritants, or lack of perceived asthma severity. CONCLUSIONS--The recommendations of current asthma guidelines are not reaching these patients. The issue of translating guidelines from paper to practice must be addressed before highly effective medications can have an important impact on the frequency of emergency department visits.</description><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Adult</subject><subject>Asthma - drug therapy</subject><subject>Asthma - psychology</subject><subject>Asthma - therapy</subject><subject>Biological and medical sciences</subject><subject>Canada</subject><subject>Chronic obstructive pulmonary disease, asthma</subject><subject>Cohort Studies</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Health Services Misuse</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Morbidity</subject><subject>Pneumology</subject><subject>Risk Factors</subject><subject>Treatment Failure</subject><issn>0040-6376</issn><issn>1468-3296</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtrFEEUhQtR4iS6cyv0QpKNPdaj61b3RkgGH4GgIFHcFbfrkamkH2NVTUj-vT30MOgmq4J7Pk4dPkLeMLpkTMCHvH5YSrqUS8npM7JgFdSl4A08JwtKK1qCUPCSHKd0SymtGVNH5EjJRgHIBTn_EdJd4dHkMabCj7GIzmxjdEMuXO_ijRvMY2HdBmPud8f7kEKeSUx53eMr8sJjl9zr_XtCfn7-dL36Wl59_3K5Or8q20rVuVTgqgolGOGtb4RBW3PAxksvbaMsGFVz2krTWgENQgWiNRapq5Q10FgnTsjHuXezbXtnzTQmYqc3MfQYH_WIQf-fDGGtb8Z7zShnnPOp4HRfEMc_W5ey7kMyrutwcOM2aaUE1KB24PsZNHFMKTp_-IRRvVOuJ-VaUi31pHzC3_477ADvHU_5u32OyWDnIw4mpAMmJFAANmHljIWU3cMhxninQQkl9bdfK_2bwsU1rblWE382821_-_TAv1gvp4M</recordid><startdate>19950501</startdate><enddate>19950501</enddate><creator>Dales, R E</creator><creator>Schweitzer, I</creator><creator>Kerr, P</creator><creator>Gougeon, L</creator><creator>Rivington, R</creator><creator>Draper, J</creator><general>BMJ Publishing Group Ltd and British Thoracic Society</general><general>BMJ</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>19950501</creationdate><title>Risk factors for recurrent emergency department visits for asthma</title><author>Dales, R E ; Schweitzer, I ; Kerr, P ; Gougeon, L ; Rivington, R ; Draper, J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b478t-76e44a56c3fdf93cad826a9f5f5d97d6c7820b5cbd369a6463bcda0e47dc69de3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Adult</topic><topic>Asthma - drug therapy</topic><topic>Asthma - psychology</topic><topic>Asthma - therapy</topic><topic>Biological and medical sciences</topic><topic>Canada</topic><topic>Chronic obstructive pulmonary disease, asthma</topic><topic>Cohort Studies</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Health Services Misuse</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Morbidity</topic><topic>Pneumology</topic><topic>Risk Factors</topic><topic>Treatment Failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dales, R E</creatorcontrib><creatorcontrib>Schweitzer, I</creatorcontrib><creatorcontrib>Kerr, P</creatorcontrib><creatorcontrib>Gougeon, L</creatorcontrib><creatorcontrib>Rivington, R</creatorcontrib><creatorcontrib>Draper, J</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Thorax</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dales, R E</au><au>Schweitzer, I</au><au>Kerr, P</au><au>Gougeon, L</au><au>Rivington, R</au><au>Draper, J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for recurrent emergency department visits for asthma</atitle><jtitle>Thorax</jtitle><addtitle>Thorax</addtitle><date>1995-05-01</date><risdate>1995</risdate><volume>50</volume><issue>5</issue><spage>520</spage><epage>524</epage><pages>520-524</pages><issn>0040-6376</issn><eissn>1468-3296</eissn><coden>THORA7</coden><abstract>BACKGROUND--Patients presenting with asthma to emergency departments have lost control of their disease, have significant airways obstruction, and frequently require admission to hospital. Although even one visit is not desirable, there is a more disturbing subgroup who repeatedly visit the emergency department. METHODS--To investigate the reasons for multiple emergency visits, a questionnaire was given to 448 consecutive patients presenting to the two largest adult emergency departments in Ottawa, Canada between November 1989 and April 1991. Within this cohort, those who had made at least three visits in the past year were compared with controls (only one visit in the past year). RESULTS--Although inhaled corticosteroid use increased with multiple visits (indicating increased asthma severity), only 60% of those visiting at least three times in the past year were taking inhaled corticosteroids. Chronic undermedication relative to disease severity was apparent among the cases. The number of visits was associated with nocturnal asthma on a regular basis, work and school absenteeism, frequent visits to their regular physician, and frequent admissions to hospital. Visits were not related to psychological health, environmental allergens/irritants, or lack of perceived asthma severity. CONCLUSIONS--The recommendations of current asthma guidelines are not reaching these patients. The issue of translating guidelines from paper to practice must be addressed before highly effective medications can have an important impact on the frequency of emergency department visits.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Thoracic Society</pub><pmid>7597665</pmid><doi>10.1136/thx.50.5.520</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adrenal Cortex Hormones - administration & dosage Adult Asthma - drug therapy Asthma - psychology Asthma - therapy Biological and medical sciences Canada Chronic obstructive pulmonary disease, asthma Cohort Studies Emergency Service, Hospital - statistics & numerical data Female Health Services Misuse Hospitalization Humans Male Medical sciences Morbidity Pneumology Risk Factors Treatment Failure |
title | Risk factors for recurrent emergency department visits for asthma |
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