Poor asthma education and medication compliance are associated with increased emergency department visits by asthmatic children
Saleh Al-Muhsen1, Nour Horanieh2, Said Dulgom2, Zuhair Assiri3, Alejandro Vazquez-Tello4, Rabih Halwani1, Hamdan Al-Jahdali5
1 Prince Naif Center for Immunology Research and Asthma Research Chair, College of Medicine, King Saud University, Riyadh; Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
3 Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
4 Prince Naif Center for Immunology Research and Asthma Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
5 Department of Medicine, Pulmonary Division-ICU, King Saud University for Health Sciences, Riyadh, Saudi Arabia
Department of Pediatrics, College of Medicine, King Saud University, P. O. Box 2925, Postal Code - 11461, Riyadh
Source of Support: None, Conflict of Interest: None
BACKGROUND: Acute exacerbations of bronchial asthma remain a major cause of frequent Emergency Department (ED) visits by pediatric patients. However, other factors including psychosocial, behavioural and educational, are also reportedly associated with repetitive ED visits. Therefore, it is necessary to determine whether such visits are justifiable.
OBJECTIVE: The objective of this cross-sectional study was to identify risk factors associated with visits to ED by asthmatic children.
METHODS: Asthmatic children (n = 297) between 1-17 years old were recruited and information collected at the time of visiting an ED facility at two major hospitals.
RESULTS: Asthmatic patients visited the ED 3.9 3.2 times-per-year, on average. Inadequately controlled asthma was perceived in 60.3% of patients. The majority of patients (56.4%) reported not receiving education about asthma. Patients reflected misconceptions about the ED department, including the belief that more effective treatments are available (40.9%), or that the ED staff is better qualified (27.8%). About half of patients (48.2%) visited the ED because of the convenience of being open 24 hours, or because they are received immediately (38.4%). Uncontrolled asthma was associated with poor education about asthma and/or medication use. Patients educated about asthma, were less likely to stop corticosteroid therapy when their symptoms get better (OR:0.55; 95% CI:0.3-0.9; P = 0.04).
CONCLUSION: This study reports that most patients had poor knowledge about asthma and were using medications improperly, thus suggesting inefficient application of management action plan. Unnecessary and frequent visits to the ED for asthma care was associated with poor education about asthma and medication use. Potential deficiencies of the health system at directing patients to the proper medical facility were uncovered and underline the necessity to improve education about the disease and medication compliance of patients and their parents/guardians.