In the province of Quebec, approximately 10% of emergency department (ED) visits for asthma result in hospitalization, and one third of those who consult make more than one ED visit for asthma during the year. ED visits for asthma may reflect poor asthma control, often related to the patient’s insufficient understanding of the disease and its treatment, particularly regarding the management of asthma exacerbations. Often, patients presenting to the ED for acute asthma have had no adequate primary care follow-up and have rarely been offered asthma education. Furthermore, patients with frequent ED visits tend to be significantly less knowledgeable about asthma control, and have poorer asthma-management knowledge and skills.
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| Asthma education |
A multicenter study done in the United States and Canada showed that although most ED physicians considered asthma education to be important, only 16% of academic medical centers reported offering such programs. Practice guidelines indicate that a structured educational intervention should be part of the general management of the disease in order to reduce asthma-related morbidity. This is particularly true for patients with the highest morbidity, including those consulting at the ED for acute asthma.
Asthma education can reduce asthma-related morbidity and acute care needs, and has been particularly successful in patients with the highest asthma-related morbidity. We previously reported a comparison of three modes of intervention offered to patients consulting at the ED for acute asthma: (1) usual care, (2) a short intervention by the ED physician including verification of inhaler use and discussion of an action plan, and (3) the initiation of an educational intervention at the ED with educational follow-up at one of the asthma education centers (AECs) of the Quebec Asthma and COPD Network, formerly the Quebec Asthma Education Network.
A short intervention, including teaching inhaler technique and the use of an action plan provided by the ED physician, led to short-term benefits, while the same intervention combined with referral to an AEC resulted in more marked and continuous improvement of most asthma-control parameters, including a persistent reduction of ED visits.
