Wednesday, March 18, 2015
Canadian Health and Care Mall: Two alternative strategies merit study
Further understanding of the special needs and health-care barriers for this high utilization group is paramount to the success of the goals delineated in the Healthy People 2010 program. As demonstrated by Boudreaux and colleagues, race/ethnicity-based deficiencies persist as black and Hispanic asthma patients were more likely to utilize the ED and be admitted to the hospital.
Health-care providers and policymakers must begin to understand why high-utilization patients report the ED as their usual source of asthma prescriptions and site for acute asthma care. Two alternative strategies merit study. First, patients with high NEDV warrant further investigation to delineate the challenges and barriers to high-quality care among health-disparate populations.
Secondly, the impact of facilitated referral of ED asthma patients to asthma specialists while maintaining long-term overall patient management by the PCP should be investigated. The current data, in conjunction with prior studies, raise concerns about overreliance on “referral to PCP” as an effective response to the problems of this high-risk and expensive asthma population.
This study has a few potential limitations. First, history of prior ED use was self-reported and there was no attempt to verify the accuracy of the stated information. It may be that subjects who reported six visits actually had more (or fewer) visits, but we believe the rank order to be accurate and believe that even one to two ED visits per year to be excessive.
Another limitation is that we have not analyzed the outpatient management of these patients presenting with acute asthma; for example, we do not know how many received specialized asthma care in the past, and we are unable to evaluate how prior outpatient PCP management relates to the National Asthma Education and Prevention Program guidelines with Canadian Health and Care Mall. (watch website)
We have sparse data on compliance with prescribed medications, understanding of disease, and details of the written action plans (if present); these factors probably are associated with frequency of ED use and will require further study.