Clinical study
The impact of follow-up physician visits on emergency readmissions for patients with asthma and chronic obstructive pulmonary disease: a population-based study

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Abstract

Purpose

To examine the relation between follow-up office visits after emergency discharge and the risk of emergency readmissions in patients with asthma or chronic obstructive pulmonary disease (COPD).

Subjects and methods

We used population-based data to identify all patients in Alberta, Canada, who had at least one emergency visit for asthma or COPD between April 1, 1996, and March 31, 1997 (N = 25 256). A Cox proportional hazards model was used to estimate the adjusted relative risk (RR) of a repeat visit to an emergency department within 90 days of an initial emergency visit in patients who did or did not have an office follow-up within the first 30 days.

Results

There were 7829 patients (31%) who had an office visit during the 30 days after their initial emergency encounter. Follow-up visits were associated with a significant reduction in the 90-day risk of an emergency readmission (RR = 0.79; 95% confidence interval [CI]: 0.73 to 0.86). Sensitivity analyses showed that a follow-up visit was inversely associated with a repeat emergency visit after adjusting for age, sex, area of residence, and income.

Conclusion

Although these data should be interpreted with caution because of missing information on factors such as quality of care, they suggest that follow-up office visits are effective in reducing early relapses in patients who have been recently treated in emergency departments for asthma or COPD.

Section snippets

Study design and patient data

We conducted a population-based cohort study of all patients in Alberta, Canada, who were admitted to emergency rooms with asthma or COPD as their principal diagnosis. In accordance with the Canada Health Act, Alberta has a single-payer, publicly funded health care system that provides universal health care coverage to all residents. Patient encounter data were obtained from medical record registries maintained by Alberta Health and Wellness. From the physicians’ claims registry, we identified

Results

Of the 25 256 persons who were admitted to an emergency department for asthma or COPD during the study period, 2610 (10%) had a repeat emergency visit, and 7829 (31%) had at least one follow-up visit with a physician during the month following discharge from their initial emergency visit. Of the patients who had a follow-up physician visit, 6643 (85%) had a visit with a general practitioner, while 1186 (15%) had a visit with a specialist.

Table 1 shows the demographic and clinical

Discussion

We found that an early follow-up visit after an emergency encounter was associated with a significant reduction in the risk of emergency readmissions among patients with asthma and COPD. When asthma and COPD are analyzed together, office visits within the first 30 days of the initial admission to the emergency department were associated with 21% fewer readmissions during the first 90 days after discharge. In patients with asthma, follow-up visits were associated with 25% fewer emergency

Acknowledgements

We thank Thomas Marrie, MD, and Finlay McAlister, MD, for their helpful review of the manuscript.

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