SELECTED ARTICLES FROM THE RECENT LITERATURE 2003

11/26/03

Asthma intervention program prevents readmission in high healthcare users

Summary
A large portion of asthma healthcare costs is due to in-patient hospitalization. This is particularly true for a small subset of asthmatics who have been hospitalized repeatedly. Castro et al of the Washington Univ. School of Medicine in St. Louis, MO chose 96 asthmatics (mostly young African-American women) with histories of frequent healthcare use for acute asthma including a current hospitalization. They were randomized to receive intervention by an asthma nurse specialist (n=50) or a usual care group (n=461) for 6 months. In that period there were 31 hospitalizations in the nurse intervention group, 71 in the control group (p=0.04 for the difference). There was an associated: 1) marked reduction in the number of days lost from work or school in the nurse intervention group (p=0.02) and 2) substantial reduction in direct and indirect health care costs (p=0.03). However, there was no significance in the frequency of Emergency Dept. visits by the patients in the intervention vs the control groups.

Reference
Am J Respir Crit Care Med 2002;168:1095-9

Editor's Comments
The findings in this study are very similar to that reported by clinical investigators in my institution (the Univ of Pennsylvania Medical Center). A special Asthma Treatment Clinic was set up to care for individuals with histories of repeated hospitalizations need for acute asthma exacerbation. After the first year of the program there was a marked reduction in the frequency of hospitalization for asthma flares (when compared to the frequency in the same subjects before they were enrolled in this special clinic). My understanding is that major factors in the efficacy of this clinic included: 1) intensive and repeated asthma education; 2) close contact between nurse specialists and physicians and the patients involved. The patients were encouraged to keep in close contact with the staff of the clinic. If a patient did not appear for a scheduled visit, he/she was contacted very soon by telephone by a nurse specialist and treatment was expedited.

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