Smith, S. R., Jaffe, D. M., Fisher Jr, E. B., Trinkaus, K. M., Highstein, G., & Strunk, R. C. (2004).The Journal of Pediatrics,145, 772-777.
Asthma is the most common pediatric chronic illness. Treatment of this condition has improved, but it is still related to significant morbidity and mortality. Poor urban children are disproportionately affected by mortality. Reasons for this may be related to poor access to care, lack of financial resources for healthcare, and lack of education about the severity of the illness. Many urban children receive acute asthma care in emergency departments (EDs) but do not follow up with primary care providers (PCPs) for chronic asthma management and education. The purpose of this study was to improve follow-up with PCPs after acute emergency room pediatric asthma visits using a combination of telephone asthma coaching and monetary incentives.
The positive outcome of this study demonstrated that there was a significant difference between the intervention (35%) and the control (19%) groups in the proportion of children who returned for a 2-week follow-up visit with the PCP. A more sobering way to examine the data is to note that even with telephone coaching (two calls in the first week after the ED visit) and a monetary incentive of $15, 65% of the children in the intervention group were not seen for a 2-week follow-up visit. In addition, the intervention had no effect on subsequent asthma visits, ED visits, or hospitalizations.
The plight of poor urban families cannot be cured with two telephone calls and $15. Clearly, more global interventions are needed than this short-term "band aid." There are numerous barriers to care for this population and pediatric nurses have a wonderful opportunity to provide and study stronger, more sustained interventions. Asthma nurses who make home visits on a regular, ongoing basis may be much more effective in reducing asthma morbidity and mortality in vulnerable populations.
Comment by Terri H. Lipman