342 - Primary care provider perceptions of emergency providers initiating inhaled corticosteroid controller medications in the ED

Poster Number: 342
Publication Number: 342.204

Katina M. Summerford, Phoenix Children's Hospital, Phoenix, AZ, United States; Blake Bulloch, Phoenix Children's Hospital, Phoenix, AZ, United States; Darcey M. Winterland, Phoenix Children's Hospital, Tempe, AZ, United States; Jodi P. Carter, Valleywise Health Medical Center, Phoenix, AZ, United States; Edward L. Swing, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Asthma is one of the leading chronic illnesses of childhood, with significant morbidity and impact on health care utilization, and the third leading cause of hospitalization among children. Emergency department visits for acute asthma are a key indicator of poorly controlled asthma, and the rate of emergency visits remains high. Inhaled corticosteroids are the mainstay of treatment for control of asthma, and recent guidelines from the National Asthma Education and Prevention Program advocate for prescribing ICS in the ED. However, multiple studies have demonstrated that children with asthma often do not receive recommended preventive care and most do not follow up with a PCP after an ED visit. Unfortunately, ED physicians are unlikely to initiate ICS during an ED visit.

Objective: National Asthma Guidelines recommend that ED physicians consider initiating controller medications (CM) in poorly controlled asthmatics. However, this does not often occur. The goal of this study was to assess PCP beliefs and attitudes regarding ED initiation of CM for children with persistent asthma symptoms at a local level.

Design/Methods: This was a cross-sectional Redcap survey of Pediatric providers employed by our hospital. The survey posed questions regarding beliefs, barriers, and support for national guideline recommendations based on a case scenario as previously employed by Sampayo, et al.

Results: 41 of an eligible 50 providers responded (82%). When presented with the vignette of a child with persistent asthma, 88% of PCPs felt it was appropriate for the ED physician to initiate controller medications. Most (65%) PCPs supported the national guideline recommendation. Only 10% opposed the practice in any circumstances. Beliefs supporting this practice included the following: opportunity to capture patients lost to follow-up (90%), reinforcement of daily use of controller medications (90%), and controller medication may shorten an acute exacerbation (75%). Barriers included lack of time for education in ED (63%), reinforcement of ED use for primary care (46%), lack of PCP communication (53%), and inability to assess severity appropriately (36%). Most (87%) PCPs expect communication from the ED provider.Conclusion(s): Most pediatricians supported the practice of ED physicians initiating controller medication during an acute visit for asthma.