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Changing the process of care and practice in acute asthma in the emergency department: experience with an asthma care map in a regional hospital

Published online by Cambridge University Press:  21 May 2015

Duncan Mackey ,
Marlene Myles ,
Carol H. Spooner ,
Harris Lari ,
Leslie Tyler ,
Sandra Blitz ,
Ambikaipakan Senthilselvan  and
Brian H. Rowe
Duncan Mackey
Affiliation:
Lethbridge Regional Hospital, Lethbridge, Alta. Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Marlene Myles
Affiliation:
Lethbridge Regional Hospital, Lethbridge, Alta.
Carol H. Spooner
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Harris Lari
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Leslie Tyler
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Sandra Blitz
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Ambikaipakan Senthilselvan
Affiliation:
School of Public Health Sciences, University of Alberta, Edmonton, Alta.
Brian H. Rowe*
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta. School of Public Health Sciences, University of Alberta, Edmonton, Alta.
*
Department of Emergency Medicine, University of Alberta, 1G1.43 Walter Mackenzie Health Sciences Center, 8440-112 St., Edmonton AB T6G 2B7; brian.rowe@ualberta.ca

Abstract

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Introduction:

Despite the frequency of acute asthma in the emergency department (ED) and the availability of guidelines, significant practice variation exists. Asthma care maps (ACMs) may standardize treatment. This study examined the use of an ACM to determine its effects on patient management in a regional hospital.

Methods:

Patients aged 2 to 65 years who presented to the ED with a primary diagnosis of acute asthma were enrolled in a prospective study that took place 5 months before (pre) and 5 months after (post) ACM implementation. Research assistants using a standardized questionnaire abstracted data through direct patient interviews and then followed up at 2 weeks with a standardized telephone interview.

Results:

Overall, 71 pre patients and 70 post patients were enrolled. Characteristics in both groups were similar. The care map was used in 100% of the cases during the post period. The mean length of stay in the ED for the pre, compared with the post period, was similar (2 h 14 min v. 2 h 25 min; p = 0.60), as were admission rates (11% v. 9%; p = 0.59). Systemic corticosteroid use was similar (62% v. 57%; p = 0.56); however, the total number of β-agonists (2 v. 4 treatments; p = 0.002) and anticholinergics (1 v. 2 treatments; p < 0.001) administered in the ED was higher during the post period. Prescriptions for oral (73% v. 60%; p = 0.15) and inhaled (78% v. 78%; p = 0.98) corticosteroids at discharge remained the same. Relapse rates at follow-up were unchanged (29% v. 34%; p = 0.52).

Conclusion:

This study provides evidence that implementation of an ACM increased acute bronchodilator use; however, prescribing preventive medications did not increase. Further research is required to evaluate other strategies to improve asthma care by emergency physicians.

Keywords

asthmacorticosteroidspreventionguidelines
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 5 , September 2007 , pp. 353 - 365
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

1. Mannino, DM, Homa, DM, Pertowski, CA, et al. Surveillance for asthma – United States, 1960–1995. MMWR CDC Surveill Summ 1998;47:1–27.Google ScholarPubMed
2. Weiss, KB, Sullivan, SD, Lyttle, CS. Trends in the cost of illness for asthma in the United States, 1985–1994. J Allergy Clin Immunol 2000;106:493–9.Google Scholar
3. Weiss, KB, Sullivan, SD. The health economics of asthma and rhinitis. I. Assessing the economic impact. J Allergy Clin Immunol 2001;107:3–8.Google Scholar
4. Krahn, MD, Berka, C, Langlois, P, et al. Direct and indirect costs of asthma in Canada, 1990. CMAJ 1996;154:821–31.Google ScholarPubMed
5. Weber, EJ, Silverman, RA, Callaham, ML, et al. A prospective multicenter study of factors associated with hospital admission among adults with acute asthma. Am J Med 2002;113:371–8.Google Scholar
6. Boulet, LP, Becker, A, Berube, D, et al; Canadian Asthma Consensus Group. Canadian asthma consensus report, 1999. CMAJ 1999;161:S1-S61.Google Scholar
7. Program NAE. Expert panel report II: guidelines for the diagnosis and management of asthma. Bethesda (MD): National Institutes of Health; 1997.Google Scholar
8. British Thoracic Society; Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. Thorax 2003;58(Suppl 1):1–94.Google Scholar
9. Cabana, MD, Rand, CS, Powe, NR, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999;282:1458–65.Google Scholar
10. Marrie, TJ, Lau, CY, Wheeler, SL, et al. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. JAMA 2000;283:749–55.Google Scholar
11. Rowe, BH, Chahal, AM, Spooner, CH, et al. Increasing the use of anti-inflammatory agents in acute asthma in the emergency department: Experience with an asthma care map. Can Respir J. In press.Google Scholar
12. Jadad, AR, Moher, M, Browman, GP, et al. Systematic reviews and meta-analyses on treatment of asthma: critical evaluation. BMJ 2000;320:537–40.Google Scholar
13. Cydulka, RK, Rowe, BH, Clark, S, et al. Emergency department management of acute exacerbations of chronic obstructive pulmonary disease in the elderly: the Multicenter Airway Research Collaboration. J Am Geriatr Soc 2003;51:908–16.CrossRefGoogle ScholarPubMed
14. Rowe, BH, Bota, GW, Clark, S, et al; MARC Investigators. Comparison of Canadian versus US emergency department visits for acute asthma. Can Respir J. In press.Google Scholar
15. Emerman, CL, Woodruff, PG, Cydulka, RK, et al. Prospective multicenter study of relapse following treatment for acute asthma among adults presenting to the emergency department. Chest 1999;115:919–27.CrossRefGoogle ScholarPubMed
16. Grunfeld, A, Beveridge, RC, Berkowitz, J, et al. Management of acute asthma in Canada: an assessment of emergency physician behavior. J Emerg Med 1997;15:547–56.Google Scholar
17. Emond, SD, Camargo, CA Jr, Nowak, RM. 1997 national asthma education and prevention program guidelines: a practical summary for emergency physicians. Ann Emerg Med 1998;31:579–89.CrossRefGoogle ScholarPubMed
18. Rowe, BH, Spooner, C, Ducharme, FM, et al. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev 2000;(2):CD002178.Google Scholar
19. Rowe, BH, Spooner, CH, Ducharme, FM, et al. Corticosteroids for preventing relapses following acute exacerbations of asthma. Cochrane Database Syst Rev 2000;(2):CD000195.Google Scholar
20. Rowe, BH, Bota, GW, Fabris, L, et al. Inhaled budesonide in addition to oral corticosteroids to prevent relapse following discharge from the emergency department: a randomized controlled trial. JAMA 1999;281:2119–26.Google Scholar
21. Edmonds, ML, Camargo, CA Jr., Brenner, B, et al. Inhaled steroids in acute asthma following emergency department discharge. Cochrane Database Syst Rev 2000;(3):CD002316.CrossRefGoogle Scholar
22. Edmonds, ML, Camargo, CA Jr, Brenner, BE, et al. Replacement of oral corticosteroids with inhaled corticosteroids in the treatment of acute asthma following emergency department discharge. Chest 2002;121:1798–805.Google Scholar
23. Rowe, BH, Edmonds, ML. Inhaled corticosteroids for acute asthma after emergency department discharge. Ann Emerg Med 2000;36:477–80.CrossRefGoogle ScholarPubMed
24. Lau, J, Antman, EM, Jimenez-Silva, J, et al. Cumulative meta-analysis of therapeutic trials for myocardial infarction. N Engl J Med 1992;327:248–54.Google Scholar
25. Hayward, RS, Guyatt, GH, Morre, KA, et al. Canadian physician’s attitudes about and preferences regarding clinical practice guidelines. CMAJ 1997;156:1715–23.Google Scholar
26. Scribano, PV, Lerer, T, Kennedy, D, et al. Provider adherence to a clinical practice guideline for acute asthma in a pediatric emergency department. Acad Emerg Med 2001;8:1147–52.Google Scholar
27. Emond, SD, Woodruff, PG, Lee, EY, et al. Effect of an emergency department asthma program on acute asthma care. Ann Emerg Med 1999;34:321–5.Google Scholar
28. Rowe, BH, Colman, I, Diner, B, et al. Anti-inflammatory treatment for asthma in Canadian emergency departments. Am J Respir Crit Care Med 2003;167:A773.Google Scholar
29. Krym, VF, Crawford, B, Macdonald, RD. Compliance with guidelines for emergency management of asthma in adults: experience at a tertiary care teaching hospital. Can J Emerg Med 2004;6:321–6.Google Scholar
30. Grimshaw, JM, Thomas, RE, MacLennan, G, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004;8:1–72.Google Scholar