Educational and long-term therapeutic intervention in the ED: Effect on outcomes in adult indigent minority asthmatics

Minorities have increased morbidity and mortality rates resulting from asthma. The segment of minorities that is socioeconomically depressed often uses the emergency department (ED) as their primary site of medical care. For these reasons, we provided major long-term therapeutic intervention as well as intensive education in the ED for indigent adult African American asthmatics. We intervened in the cases of 30 patients who were frequent visitors to the ED over the previous 2 years. The intervention consisted of 1 hour of education in the ED before discharge regarding the prevention of asthma, the importance of decreasing inflammation as a means of improving asthma control, self-monitoring with a peak flow meter, and a demonstration of correct inhalation technique with metered-dose inhalers and a spacer device. Further, the intervention included management consistent with recent NIH Guidelines, stressing inhaled corticosteroids. After the intervention in the ED, patients were scheduled for follow-up asthma clinic visits. Outcome measures were ED visits and hospitalizations for 1 year after the ED intervention. Using the same inclusion/exclusion criteria, a retrospective control group of 22 patients for the same time period was compared with the intervention group. Before our intervention, the mean number of ED visits per patient for the previous 2 years was 4.4 ± 2.7, and after the intervention, 2.6 ± 2.6 (P< .01). The control group did not show a difference in the number of ED visits (3.4 ± 2.6 before and 3.5 ± 2.7 after, P = .96). After the intervention, the mean number of hospitalizations decreased significantly in the study group (P< .01). A nonsignificant reduction in hospitalizations was seen in the control group (P = .07). The amount of decrease was not significantly different between groups (P = .37). Only 6 of 30 patients routinely kept subsequent clinic appointments. Innovative approaches are needed to improve clinical outcomes in indigent adult minority asthmatics. These data suggest that long-term intervention and education in the ED reduces subsequent ED visits for asthma. Further studies in larger patient populations are recommended.