מתןך medicontext.co.il
WESTPORT, CT (Reuters Health) – The results of a survey of 375 predominantly low-income, African-American adults with asthma living in Harlem, New York, provides a profile of the asthma patient who uses the ED frequently.
They are typically patients with more severe, poorly managed asthma with serious comorbid conditions who use the ED to augment, not substitute for, regular medical care. Dr. Jean G. Ford and colleagues of the Harlem Lung Center report their study of patterns and predictors of asthma-related ED use in the October issue of Chest.
Sixty-nine percent of respondents named the ED as their "preferred" source of asthma care, despite having a regular physician. In analyses controlled for disease severity, visiting a primary care physician for asthma, not an asthma specialist, was a significant predictor of frequent ED use. "General medical care alone, even when available, did not prevent repeated ED visits," they report.
Contrary to prior studies, asthma severity emerged as a more important predictor of frequent ED use than psychosocial factors such as depressive symptoms. Psychosocial characteristics were not predictive of frequent ED use after controlling for disease severity.
Compared with one-time users, frequent ED users were more likely to have general health problems in addition to asthma, a finding that highlights the need for integrated disease management in this population, the researchers say. "Focusing on asthma management alone is insufficient for Harlem and similar communities," they write.
These findings identify a group of patients with "an especially high risk for recurrent visits to the ED for asthma…who should be targeted for more aggressive, preventive interventions," Dr. Ford told Reuters Health.
Editorialist Dr. Valentin Popa of the University of California at Davis in Sacramento says the fact that most asthmatics in this study had a primary care physician suggests "undertreatment" of asthma rather than a lack of access to a doctor. He adds that this undertreatment appears to be the result of insufficient physician involvement.
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