Allergy and Airway: Allergy - Asthma Slide |

Home Supply of Emergency Oral Steroids and Reduction in Asthma Healthcare Utilization FREE TO VIEW

Lisa Sarzynski, MD; Elizabeth Allen, MD; Nancy Ryan-Wenger, PhD; Tiffany Turner, MD
Author and Funding Information

Nationwide Children's Hospital, Columbus, OH

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):12A. doi:10.1016/j.chest.2016.08.015
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SESSION TITLE: Allergy - Asthma Slide

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 26, 2016 at 07:30 AM - 08:30 AM

PURPOSE: Asthma is responsible for high rates of healthcare utilization in the pediatric population. Previous studies have shown that early provision of oral steroids on presentation to the emergency department(ED) reduces hospitalizations. The impact of prescribing a home supply of oral steroids to facilitate institution of this therapy even prior to need for ED care during acute asthma exacerbations has not been well studied. We evaluated the outcomes of patients with moderate to severe persistent asthma who had been treated by a pediatric pulmonary provider for at least 12 months prior to prescription of a home oral steroid supply as part of a quality improvement project. Instructions for appropriate oral steroid use were provided verbally and were incorporated into the patient’s asthma action plan(AAP). The objective of our study was to determine if this provision of a home oral steroid supply had a significant impact on subsequent health care utilization as measured by the rate of ED visits, inpatient(IP) visits, and pediatric intensive care unit(PICU) stays in the following year.

METHODS: A retrospective chart review was performed limited to moderate to severe persistent asthma patients ages 2 to 18 who were followed in the Pediatric Pulmonary Clinic between 2012-2014. 132 patients were identified from this group who had been prescribed home emergency oral steroids based on their AAP and who had been followed in the Pulmonary Clinic for at least a year prior to this intervention. The rates of asthma related ED visits, inpatient stays, and PICU stays per person per year were compared from 24 months prior to the initial incorporation of oral steroids into the AAP to rates from 12 months prior to the prescription incorporation. This 2 year pre-intervention evaluation was done to determine if patients’ health care utilization was already declining prior to the oral steroid intervention. Rates from 12 months prior to the steroid incorporation date were then compared to 12 months after the intervention using the Wilcoxon Paired Ranks Test.

RESULTS: On average, the 132 patients had been followed in the Pediatric Pulmonary clinic for 2.8±1 years prior to intervention. Average age at time of intervention was 10±3.8 yrs. 57% were male. 63% had Medicaid based insurance. Their ED, IP, and PICU usage rates had been stable during the preceding two years. Following the home oral steroid supply intervention, there was a decline in ED visit rates from a mean of 0.67 events per patient per year in the 12 months prior to the oral steroids prescription date to 0.39 visits per patient per year in the 12 months after the intervention (P=0.001). There was a trend towards decline in IP and PICU stay rates that was not statistically significant.

CONCLUSIONS: Our results suggest that incorporation of oral steroids in the home asthma management plan of moderate to severe persistent asthmatics followed in the pediatric pulmonary clinic for at least a year prior to this intervention is associated with a significant decline in ED visit rates and a trend towards improvement in IP or PICU rates.

CLINICAL IMPLICATIONS: Practitioners should consider use of oral steroids in the home management plan of moderate to severe asthmatics followed in the pulm. clinic for at least a year.

DISCLOSURE: The following authors have nothing to disclose: Lisa Sarzynski, Elizabeth Allen, Nancy Ryan-Wenger, Tiffany Turner

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