Asthma Coaching in the Pediatric Emergency Department

Authors

  • Sharon R. Smith MD,

    Corresponding author
    1. Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO.
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  • David M. Jaffe MD,

    1. Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO.
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  • Gabrielle Highstein PhD,

    1. Health Behavior Research, Department of Medicine and Pediatrics, Washington University School of Medicine, St. Louis, MO.
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  • Edwin B. Fisher PhD,

    1. Health Behavior Research, Department of Medicine and Pediatrics, Washington University School of Medicine, St. Louis, MO.
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  • Kathryn M. Trinkaus PhD,

    1. Division of Biostatistics, Washington University School of Medicine, St. Louis, MO.
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  • Robert C. Strunk MD

    1. Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO.
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Division of Emergency Medicine, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106. Fax: 860-545-9202; e-mail: srsmith@ccmckids.org.

Abstract

Objectives: Coaching and monetary incentives have been used to modify medical behavior of individuals with several chronic diseases, including asthma. The authors performed a randomized, controlled trial of an intervention combining asthma coaching during an emergency department (ED) visit for asthma, and monetary incentive to improve follow-up with primary care providers (PCP).

Methods: Subjects were parents of children 2–12 years of age, with Medicaid or no medical insurance, receiving treatment for asthma in the ED. The primary outcome was a verified PCP visit for asthma within two weeks of the index ED visit. All parents received 15 for their time in the ED. Parents in the intervention group were told that they would receive an additional 15 monetary incentive if a PCP visit was completed. The coach engaged in a dialogue with the parent during the ED visit, and discussed the importance and advantages of seeking follow-up care with the child's PCP. All parents received the usual discharge instructions, including advice to see the PCP within three days.

Results: The authors enrolled 92 parents; outcome data were available for 86 (42 controls, 50 intervention). Demographic characteristics were similar in both groups. There was no significant difference in the proportion of patients who had follow-up PCP visits between the intervention (22.0%; 95% confidence interval [95% CI] = 11.5% to 36.0%) and control (23.8%; 95% CI = 12.0% to 39.4%) groups (p = 0.99).

Conclusions: An intervention combining asthma coaching during acute ED visits and a monetary incentive to return for a PCP visit does not appear to increase follow-up with the PCP.

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