Grant: Operating Grant

Asthma attacks are common causes of Emergency Department (ED) visits, and can result in school and work absenteeism, hospitalization, and significant costs to the health care system. Our previous studies suggested most Canadian emergency physicians follow guideline recommendations; however, follow-up care by primary care providers (PCPs) after ED visits are often delayed (only a third of patients are seen within two weeks). Moreover, preventive interventions (e.g., action plans, immunizations, and education) are rarely implemented in this population. Ineffective management after asthma attacks could increase the risk of undesired events. The objective of this study is to determine if ED-directed guidance on follow-up and self-management provided to PCPs and patients respectively reduces relapse within 90 days. This randomized controlled trial includes asthmatics 17-55 years old who are treated and discharged from EDs in Edmonton and Calgary. Patients must have a PCP with whom to follow-up or one will be found for them. At discharge, 366 patients will be randomized into: a) Usual ED care (PCPs receive a faxed copy of the ED chart); b) Usual ED care + personalized fax to the patients' PCP (e.g., copy of the ED chart and opinion-leader letter encouraging follow-up and management suggestions); or c) Usual ED care + personalized fax to the patients' PCP + involvement of a case manager who will encourage patients to pursue follow-up, provide management review and offer brief education within the next week. In-ED and post-ED medical treatment will be left to the emergency physicians' discretion. Phone calls at 30 and 90 days will document relapses, follow-up visits, and patients' health-related quality of life; health care-related costs will also be measured. This work will present health care providers from the ED and primary care fields with an opportunity to optimize asthma management in a group of asthmatics with the highest risk for poor short and long-term outcomes.