Wednesday, December 3, 2014

Patients with high NEDV

Furthermore, future study might assess the psychosocial problems and barriers to health-care access of this high-utilization group. Finally, one must consider that this study examines only patients who presented to the ED with an acute exacerbation. Since the study is specific to ED patients and not population based, it may not be generalizable to all asthma patients. 

For example, the value of primary care of asthmatic adults would be considerably less in this population; patients receiving excellent primary asthma care are much less likely to visit the ED, and therefore would be underrepresented in this large cohort. However, since our focus is on the characteristics of frequent visitors to the ED, and the development of strategies to potentially help this patient population, the findings are of direct relevance to our objectives.  

Summary Patients with high NEDV were more likely to be nonwhite, of lower socioeconomic status, have Medicaid insurance, and have higher chronic asthma severity. Patients with six or more ED visits accounted for 20% of consecutive ED patients with acute asthma, and 68% of all prior ED visits in the past year. National guidelines recommend specific ED treatments followed by referral to PCP, with unclear recommendations about if and when to refer patients to asthma specialists. 

We found no relation between PCP status and NEDV. Efforts to reduce high ED utilization through provision of a PCP referral may be inadequate for this frequent-flier population. Although longitudinal care is surely important, attempts to reduce frequent ED asthma visits may be better directed toward more specific preventive and educational needs. Table 1 — Pulmonary Function Measured at Baseline, 5 min, 10 min, and 20 min after the 90% and 100% Peak Vo2 Exercise Bouts
Variables Baseline 5-min 10-min 20-min
90% peak Vo2 4.52 4.42 4.5 4.47
100% peak Vo2 (116%) 4.33 4.31
PEF, L/s
90% peak Vo2 7.57 7.59 7.33 7.68
100% peak Vo2 (103%) 7.59 7.24
FEVj, L/s
90% peak Vo2 3.54 3.64 3.59 3.6
100% peak Vo2 (104%) 3.57 3.45
FEF25-75, L/s
90% peak Vo2 2.86 3.13 2.98 3.07
100% peak Vo2 (72%) 3.17 2.96

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