Communication during pediatric emergency department visits for asthma: The effect of patient education on outcomes.

摘要

Poor children living in the inner-city are shown to receive episodic care for their asthma in emergency departments (EDs), limiting the receipt of ongoing preventive care, particularly education regarding disease self-management and the prescribing of appropriate medications. As provider time in the ED may be limited, it is essential to know what components of provider communication are most important to teach and may have the most impact on patient outcomes. As such, the goals of this research are to: (1) describe the process of information exchange during pediatric ED visits for asthma between providers and parents and providers and children and (2) evaluate the relationship between the quality of education and outcomes such as patient morbidity and parent satisfaction with care.; This is an observational study of prospectively collected data. Patients were recruited in pediatric EDs located in seven inner-city sites including Baltimore, Chicago, New York (two sites), Detroit, St. Louis, and Cleveland. The participants were children, four to nine years of age, of English or Spanish speaking families who live in selected inner-city census tracts in which 20% or more of households had incomes below the 1990 federal poverty level. Children had to have asthma in the past.; Each ED visit was audiotape recorded. All portions of the audiotape pertaining to asthma medications and triggers were coded to capture provider behaviors including providing complete medication or trigger information and being parent- or child-centered. Parental satisfaction with the ED visit was assessed based on a 9-item questionnaire administered prior to discharge from the ED. Child morbidity was assessed one month following the ED visit based on asthma symptoms and limitations in activities from a 5-item questionnaire.; Patients of providers who had both a parent- and child-centered style, (that is, engaged in partnership behaviors, were interpersonally sensitive, and provided information) had lower asthma morbidity scores one month following the ED visit. Providers were more likely to give good counseling about medications to parents of children who were admitted to the ED with severe asthma.