Systemic Review Of Follow Up After Acute Asthma Episodes Improving Pediatric Outcomes (Research Paper Sample)

A Systemic Review of Follow up after Acute Asthma Episodes Improving Pediatric Outcomes
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Introduction
Background and Significance
Asthma is among one of the most common childhood diseases. Current data from the Center for Disease Control and Prevention (CDC) shows that an estimated 9.3% of adolescents between the ages of 11-21 have been diagnosed with asthma at some point (CDC, 2016). Furthermore, the CDC data shows that highest rates of asthma are found most commonly in disadvantaged populations and those with a lower socioeconomic household (Center for Disease Control, 2016).
Its impacts are wide-ranging and impact the entire health care system and daily patient life. An Environmental Protection Agency Report from 2017 shows that poor asthma control was listed as a direct cause of approximately over 14.7 million missed school days (Environmental Protection Agency, 2017). Further negative impacts place the strain on the entire health-care and school systems (Bosnic-Anticevich, Stuart, Mackson, Cvetkovski, Sainsbury, Armour, Mavritsakis, Mendrela, Travers-Mason, & Williamson, 2014).
For many patients achieving good asthma control can be particularly challenging. This difficulty can be traced to multiple factors, which include health care system failures. These failures result in a lack of patient compliance, clinician inability to follow established treatment guidelines, and lack of primary care buy-in regarding patient education. Previous research has shown that properly followed established treatment guidelines result in better rates of asthma control rates for most populations. These guidelines include proper primary prevention and post emergency room care. Furthermore, it is expected that implementation of treatment guidelines could result in 95% of patients with well-controlled asthma (Clayton, 2014).
Systematic Review
The aim of this systematic review is to review the current state of the science regarding pediatric asthma management after an emergency room visit for an episode of acute exacerbation. Current research has shown conflicting evidence whether having early access to primary after an emergency room reduces rates of recidivism. Other findings show that many asthma patients do not return for a primary follow-up visit even when having universal access to care, which may further exacerbate the problem of poorly, controlled asthma (Li, To, Guttman, 2012).
To further study the scope of the problem and current research regarding this or any other potential research problem one must perform a systematic review of current literature. A systematic review is essential to determine what research has already been done, what findings are available, and help identify areas that require further research to understand the topic at hand entirely. Furthermore, systematic reviews can help narrow and limit the scope of the research question, determine what relevant and quality of data currently exists and will contribute to limiting focus of additional research. Lastly, and most importantly, systematic reviews are extremely useful in helping to address shortfalls in current practice and develop future practice guidelines.
The overall questions that need to be addressed are the quality of current studies regarding the relationship between primary care asthma follow-up care after emergency room visits and reduction of repeat emergency room visits. The issues of relevance to proposed study question, validity and reliability of current studies, and the pros and cons of post-emergency room primary care visits are addressed here as well.
In regards to the question of reducing the burden of recurrent visits regarding acute adolescent asthma exacerbations systematic review of the current literature has shown the need for additional research. Current research has shown conflicting evidence wither primary care follow-up, and primary intervention will limit adolescent asthma emergency room usage. By conducting a systematic review, the goal will be to determine where evidence is lacking and where a further study will be beneficial. (Dexheimer, Borycki, Chiu, Johnson, & Aronsky, 2014; Li, To, Guttman, 2012; Lougheed, 2006)
Literature Review
Five relevant studies were identified from the search process. In the first study, Li, To, and Guttmann (2012) investigated the relationship between follow-up care visits and emergency department (ED) re-visits and hospital admissions among children. The researchers emphasized that ED and hospitals play a significant role in providing acute asthma care to children. They also noted that it is important to follow national and international guidelines with regards to follow-up visits to prevent relapse or hospitalization due to current or future exacerbations (Li et al., 2012). This argument is conceivable since continuity of care is likely to minimize asthma-related ED visits. Li et al. (2012) conducted a population-based study of children aged 2-7 years using datasets from the Institute of Clinical Evaluative Sciences. The researchers focused on primary and secondary outcomes, such as hospital admission for asthma and follow up visits within 28 days. A cohort of 29,391 children was used in the study, out of which 33% had at least one follow-up visit within 28 days (Li et al., 2012). The findings indicated that most of the visits occurred within the first week and day. The number of follow-up visits ranged from 0 to 9. The factors associated with the visits included age, gender (male), income, high acuity, and prior hospitalization for asthma. Moreover, 22.1% of the children were readmitted with 29-365 days, with the number of visits to the ED ranging from 0-16. The findings indicated that follow-up was not significantly correlated with ED-visits or hospitalization. The study further established that ED re-visits were more likely to occur among younger children, individuals from lower income quintile, patients suffering from acute and chronic ailments, and those with a history of admission. Li et al. (2012) noted that children who had visited the ED at least once in the past two years were two times more likely to relapse. The researchers emphasized the need to focus on quality as well as continuity of patient care to improve the asthmatic patients’ outcomes.
In the second study, Smiley, Sicignano, Rush, Lee, and Allen (2016) investigated the outcomes of follow-up care among asthmatics who visit an emergency department in the military health system. According to the National Asthma Education and Prevention Program (NAEPP) guidelines, follow-up should be conducted within 28 days after visiting an ED to offset the possibility of asthmatic attacks. Optimization of controller management is one of the most important elements of the follow-up visit. Smiley et al. (2016) examined the characteristics linked with improved outcomes, such as medication information, which has been overlooked in many studies. The researchers hypothesized that medication information could be a crucial indicator of effective asthma follow-up visits. The retrospective observational cohort study was conducted among children aged between 2 and 17. The data was retrieved from the Department of Defense (DoD) Military Health System (MHS). The researchers utilized a sample of 10,460 patients. The findings indicated that almost half (47.5%) of the patients complied with post-primary care follow-ups, although most of them visited the hospital once. The study did not establish a relationship between follow-up and characteristics such as patients’ gender, geographic location, and season or source of ED visit. However, the researchers observed that 24% of the patients without a follow-up revisited the ED between 29-365 days compared with 21.1% of those who had complied with the follow-ups. The median time for the revisit was 156 and 159 days respectively. Moreover, hospitalization for the disease was noted among 2.2% and 2.3% of the patients who did not attend follow-up and those who did respectively. The findings indicated that a follow-up visit minimized the probability of experiencing an ED re-visit in the following year. The study further established that those who had experienced a follow-up had a greater Asthma Medication Ratio (AMR) compared with those who did not.
In the third study, Kao and Wu (2017) focused on the effect of continuity of care on ED visits among elderly, asthmatic patients in Taiwan. The researchers observed a positive correlation between continuity of care and health care outcomes. However, they noted paucity of studies focusing on the impact of COC on emergency-related ED visits among elderly patients. The researchers conducted a retrospective cohort study using data from Taiwan's health insurance claims database. The COC index was utilized to assess the number of physicians that a patient had visited in the first year and the asthma-related ED visits in the following year. Cox model was used to determine the hazard ratio between COC and ED visits. A sample of 3395 patients was used in the study with an overall mean COC of 0.73. The findings indicated that 48.5% of the patients had a perfect COC (COCI=1). Besides, the patients with low COC had a higher risk of experiencing an asthma-related ED visit compared with the subjects with perfect COC. The findings also showed that asthmatic attacks were more likely to recur among elderly patients with lower COC.
In the fourth study, Huang, Wu, Hung, and Lin (2016) explored the impacts of continuity of care on emergency department utilization among children with asthma in Taiwan. The researchers hypothesized that higher continuity of ambulatory asthma care significantly minimizes the risk of asthma-specific ED visits. However, they argued that COC has not been investig...