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The association of asthma education centre characteristics on hospitalizations and emergency department visits in Ontario: a population-based study.

Garvey NJ, Stukel TA, Guan J, Lu Y, Bwititi PT, Guttmann A - BMC Health Serv Res (2014)

Bottom Line: ED patients having access to an AEC that offered full-time, extended hours had reduced rates of adverse outcomes (adjusted relative rate [aRR] 0.78, 95% confidence interval [CI] 0.69, 0.90) compared to those with no AEC access.Hospitalized patients with access to asthma education during hospitalization had reduced rates of adverse events (aRR 0.87, 95% CI 0.75, 1.00) compared to those with no inhospital AEC access.Review of both services provided and strategies to address potential barriers to care are necessary.

View Article: PubMed Central - PubMed

ABSTRACT

Background: International guidelines recommend patient education as an essential component of optimal asthma management. Since 1990 hospital-based asthma education centres (AECs) have been established in Ontario, Canada. It is unknown whether patient outcomes are related to the level of services provided.

Methods: Using linked, population-based health administrative and hospital survey data we analyzed a population of patients aged 2 to 55 years with a hospitalization for asthma (N = 12 029) or a high acuity asthma emergency department (ED) visit (N = 63 025) between April 2004 and March 2007 and followed for three years. Administrative data documenting individuals' attendance at AECs were not available. Poisson models were used to test the association of potential access to various AEC service models (outpatient service availability and in-hospital services) with asthma readmissions, ED visits or death within 6 to 36 months following the index admission or ED visit.

Results: Fifty three of 163 acute care hospitals had an AEC (N = 36) or had access by referral (N = 17). All AECs documented use with guideline-based recommendations for AE programs. ED patients having access to an AEC that offered full-time, extended hours had reduced rates of adverse outcomes (adjusted relative rate [aRR] 0.78, 95% confidence interval [CI] 0.69, 0.90) compared to those with no AEC access. Hospitalized patients with access to asthma education during hospitalization had reduced rates of adverse events (aRR 0.87, 95% CI 0.75, 1.00) compared to those with no inhospital AEC access.

Conclusion: Although compliant with asthma guideline-based program elements, on a population basis access to asthma education centres is associated only with a modest benefit for some admitted and ED patients and depends on the level of access to services provided. Review of both services provided and strategies to address potential barriers to care are necessary.

No MeSH data available.


Related in: MedlinePlus

AEC Study: Index Visit and Main Exposure Timeframes.
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Related In: Results  -  Collection

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Fig1: AEC Study: Index Visit and Main Exposure Timeframes.

Mentions: The primary outcomes were readmission or high acuity ED visit for asthma or death from any cause during the 6 to 36 months after the index event to give patients a 6 month opportunity to access an AEC for follow up care (Figure 1). The primary exposure was access to an onsite or referral hospital-based AEC for outpatient follow up care at the time of the index event, categorized according to AEC service availability, defined as full-time or part-time, and having regular or extended hours of operation. The secondary exposure was asthma education availability to inpatients or ED patients. We could ascertain only whether the AEC service was available at the index hospital but not whether patients actually used the service.Figure 1


The association of asthma education centre characteristics on hospitalizations and emergency department visits in Ontario: a population-based study.

Garvey NJ, Stukel TA, Guan J, Lu Y, Bwititi PT, Guttmann A - BMC Health Serv Res (2014)

AEC Study: Index Visit and Main Exposure Timeframes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4233233&req=5

Fig1: AEC Study: Index Visit and Main Exposure Timeframes.
Mentions: The primary outcomes were readmission or high acuity ED visit for asthma or death from any cause during the 6 to 36 months after the index event to give patients a 6 month opportunity to access an AEC for follow up care (Figure 1). The primary exposure was access to an onsite or referral hospital-based AEC for outpatient follow up care at the time of the index event, categorized according to AEC service availability, defined as full-time or part-time, and having regular or extended hours of operation. The secondary exposure was asthma education availability to inpatients or ED patients. We could ascertain only whether the AEC service was available at the index hospital but not whether patients actually used the service.Figure 1

Bottom Line: ED patients having access to an AEC that offered full-time, extended hours had reduced rates of adverse outcomes (adjusted relative rate [aRR] 0.78, 95% confidence interval [CI] 0.69, 0.90) compared to those with no AEC access.Hospitalized patients with access to asthma education during hospitalization had reduced rates of adverse events (aRR 0.87, 95% CI 0.75, 1.00) compared to those with no inhospital AEC access.Review of both services provided and strategies to address potential barriers to care are necessary.

View Article: PubMed Central - PubMed

ABSTRACT

Background: International guidelines recommend patient education as an essential component of optimal asthma management. Since 1990 hospital-based asthma education centres (AECs) have been established in Ontario, Canada. It is unknown whether patient outcomes are related to the level of services provided.

Methods: Using linked, population-based health administrative and hospital survey data we analyzed a population of patients aged 2 to 55 years with a hospitalization for asthma (N = 12 029) or a high acuity asthma emergency department (ED) visit (N = 63 025) between April 2004 and March 2007 and followed for three years. Administrative data documenting individuals' attendance at AECs were not available. Poisson models were used to test the association of potential access to various AEC service models (outpatient service availability and in-hospital services) with asthma readmissions, ED visits or death within 6 to 36 months following the index admission or ED visit.

Results: Fifty three of 163 acute care hospitals had an AEC (N = 36) or had access by referral (N = 17). All AECs documented use with guideline-based recommendations for AE programs. ED patients having access to an AEC that offered full-time, extended hours had reduced rates of adverse outcomes (adjusted relative rate [aRR] 0.78, 95% confidence interval [CI] 0.69, 0.90) compared to those with no AEC access. Hospitalized patients with access to asthma education during hospitalization had reduced rates of adverse events (aRR 0.87, 95% CI 0.75, 1.00) compared to those with no inhospital AEC access.

Conclusion: Although compliant with asthma guideline-based program elements, on a population basis access to asthma education centres is associated only with a modest benefit for some admitted and ED patients and depends on the level of access to services provided. Review of both services provided and strategies to address potential barriers to care are necessary.

No MeSH data available.


Related in: MedlinePlus