Asthma Care Practices in Chicago-Area Emergency Departments: Practice Patterns in Relation to Guidelines
Practice Patterns in Relation to Guidelines
At the time of the survey, 90.6% of the respondents reported awareness of the NAEPP guidelines for the diagnosis and management of asthma. Of those who were aware of the guidelines, 67.2% reported that they had read them. And of those who had read the guidelines, 89.7% rated them as valuable or extremely valuable.
Nearly three fourths of the respondents indicated that their ED promoted the use of some form of asthma management guidelines for the ED staff. There were no significant differences in the frequency of guideline use among the EDs in urban vs suburban or academic vs nonacademic hospitals.
An analysis of the practice patterns of EDs that reported promoting asthma guidelines, vs those that did not, found significant differences in their approach to asthma education. Patients of the EDs with asthma guidelines were much more likely (p < 0.05) to receive some type of formal asthma education program (44.9% vs 11.6%), written asthma educational materials (64.3% vs 40.0%), and training in use of inhaler or spacer devices (38.2% vs 12.5%). cialis professional 20 mg
Asthma Care Practice Patterns in EDs of Urban vs Suburban and Academic vs Nonacademic Hospitals
Additional analyses were conducted to determine the relationship between asthma care practice patterns in the EDs of urban vs suburban and academic vs nonacademic hospitals. These analyses also revealed a few statistically significant differences. Urban hospitals reported longer ED visits for asthma than suburban hospitals (3.3 vs 2.8 h; p < 0.05). Disposition decisions appeared to occur later at urban hospitals than suburban hospitals (2.95 vs 2.35 h; p < 0.05). Also, while the overall percent of patients receiving theophylline was low, the reported use of this medication was nearly three times higher in urban hospitals than in suburban hospitals (14.2% vs 5.5% of patients; p < 0.01). EDs of urban hospitals were also more likely to include arterial blood gases as part of the assessment of persons with severe exacerbation (82.3% vs 62.9% of patients; p < 0.01). As noted above, the survey results indicate that detailed follow-up appointments were given to only a fraction of the patients at the time of discharge from the ED. However, the urban EDs were reported to have significantly higher performance in this area than the suburban hospitals (33.7% vs 16.3% of patients; p < 0.05).