By Dr. Larry Chiaramonte
What would April be without citing the wisdom of the eminent Italian-American philosopher, Yogi Berra? In a recent paper entitled “Low Rates of Controller Medication Initiation and Outpatient Follow-up After Emergency Department Visits for Asthma”* the authors say, “The investigators concluded that fewer than 20% of the children seen in the ED for an asthma exacerbation were dispensed a prescription for inhaled corticosteroids, and only 12% attended follow-up visits.”
They state further, “Asthma is one of the top 2 or 3 chronic medical conditions in childhood, on the basis of either the percentage of children affected or healthcare-related costs. Although we hypothesized that relatively low percentages of children would receive measures of preventive care after an ED visit for asthma, we did not expect such low percentages, particularly the finding that barely 5% of children received both inhaled steroids and a follow-up visit.”
This is old news to me. It has been a running theme throughout my career. The tragedy is that it continues to be “news”. One case has continued to weigh on me.
Many years ago before inhaled steroids, and managed care, we just could not get an asthmatic child in the foster-care system out of the hospital in part because of his severity and in part because no new foster parent would take him. The “Brooklyn foster parents of the year” stepped forward to care for him and took him home. Two days later he was dead on arrival at our hospital. The foster parents had taken him to multiple emergency departments in the intervening days, and no one looked at the overall picture. They were concerned only with the current visit. No one considered the signs pointing to an escalating attack.
If I were God I would change the very souls of the health care workers in all emergency departments. I would keep their focus on the here and now but add the humbling realization that it’s not enough. A long-term point of view with prevention in mind must be built into their thinking. Like Yogi, an ED physician is a backstop, but there are other players on the field. They should play like a team.
*Andrews AL, Teufel RJ 2nd, Basco WT Jr
J Pediatr. 2012;160:325-330