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Objective: Self-management is an essential part of achieving asthma control and improving long-term outcomes. While guidelines recommend the provision of written asthma action plans (AAPs), few patients presenting to emergency departments (ED) have one. This systematic review examined if individualized written AAPs reduce relapses in adults following an ED visit for acute asthma.Data sources: Comprehensive searches of seven electronic databases and grey literature were conducted.Study selections: Randomized controlled trials (RCTs) examining the effectiveness of individualized written AAPs to reduce relapses after ED visits for acute asthma were included. Study quality was determined using the Cochrane Risk of Bias (RoB) tool; intervention fidelity was assessed.Results: From 695 potentially relevant studies, three RCTs were included. The RoB was low in two studies and high in one study; description of intervention fidelity varied across studies. The provision of individualized written AAPs in adults following an ED visit for acute asthma did not reduce the risk of relapse after ED discharge (risk ratio [RR] = 0.66; 95% confidence intervals [CI]: 0.36, 1.23;I2= 40%). There was a 49% reduction in the risk of relapse after ED discharge when only studies with low RoB were pooled (RR = 0.51; 95% CI: 0.31, 0.83;I2= 0%).Conclusion: This review did not provide conclusive evidence to support the consideration of individualized written AAPs for the reduction of relapses after an ED visit; however, the low frequency of events, small number of studies and samples, and their methodological quality might play an important role in this overall finding. [ABSTRACT FROM PUBLISHER]

Objective: ED visits have been rising year on year worldwide. It has been suggested that some of these visits could be avoided if low-acuity patients had better primary care access. This study explored patients' efforts to avoid ED presentation and alternative care sought prior to presentation.Methods: Consecutive adult patients presenting to three urban EDs in Edmonton, Canada, completed a questionnaire collecting demographics, actions attempted to avoid presentation and reasons for presentation. Survey data were cross-referenced to a minimal patient dataset containing ED and demographic information.Results: A total of 1402 patients (66.5%) completed the survey. Although 89.3% of the patients felt that the ED was their best care option, the majority of patients (60.1%) sought alternative care or advice prior to presentation. Men, individuals who presented with injury only, and individuals with less than a high school education were all less likely to seek alternative care. Alternative care actions included visiting a physician (54.1%) or an alternative healthcare professional (eg, chiropractor, physiotherapist, etc; 21.2%), calling physician offices (47%) or the regional health information line (13%). Of those who called their physicians, the majority received advice to present to the ED (67.5%).Conclusions: Most low-acuity patients attempt to avoid ED presentation by seeking alternative care. This analysis identifies groups of individuals in the study region who are less likely to seek alternative care first and may benefit from targeted interventions/education. Other regions may wish to complete a similar profile to determine which patients are less likely to seek alternative care first. [ABSTRACT FROM AUTHOR]

Objective: ED visits have been rising year on year worldwide. It has been suggested that some of these visits could be avoided if low-acuity patients had better primary care access. This study explored patients' efforts to avoid ED presentation and alternative care sought prior to presentation., Methods: Consecutive adult patients presenting to three urban EDs in Edmonton, Canada, completed a questionnaire collecting demographics, actions attempted to avoid presentation and reasons for presentation. Survey data were cross-referenced to a minimal patient dataset containing ED and demographic information., Results: A total of 1402 patients (66.5%) completed the survey. Although 89.3% of the patients felt that the ED was their best care option, the majority of patients (60.1%) sought alternative care or advice prior to presentation. Men, individuals who presented with injury only, and individuals with less than a high school education were all less likely to seek alternative care. Alternative care actions included visiting a physician (54.1%) or an alternative healthcare professional (eg, chiropractor, physiotherapist, etc; 21.2%), calling physician offices (47%) or the regional health information line (13%). Of those who called their physicians, the majority received advice to present to the ED (67.5%)., Conclusions: Most low-acuity patients attempt to avoid ED presentation by seeking alternative care. This analysis identifies groups of individuals in the study region who are less likely to seek alternative care first and may benefit from targeted interventions/education. Other regions may wish to complete a similar profile to determine which patients are less likely to seek alternative care first., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)