Fran Lowry

October 18, 2011

October 18, 2011 (Boston, Massachusetts) — Pediatricians strongly support the recommendation that emergency department (ED) physicians start asthma controller medications during an acute visit to the ED, according to research presented here at the American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition.

Dr. Esther Maria Sampayo

National asthma guidelines recommend that ED physicians consider initiating long-term controller medications when children present with an acute asthma attack. However, many ED doctors are reluctant to do so, lead author Esther Maria Sampayo, MD, MPH, from the University of Pennsylvania School of Medicine, Philadelphia, said in an oral abstract session.

"One AAP study noted that less than 20% of ED doctors actually do this," Dr. Sampayo told Medscape Medical News. "When you ask them why, they say it's not their role to be the pediatrician and they shouldn't be providing long-term management."

Dr. Sampayo and her team set out to survey pediatricians directly to find out whether they were for or against the recommendation.

"We thought, why don't we just ask the pediatricians how they feel about it, because if they feel like we should be doing it, that might encourage us as ED doctors to carry out this recommendation," she said.

The researchers did a cross-sectional mail survey of a randomly selected national sample of pediatricians involved in providing primary care from the AAP.

Of the 527 pediatricians who responded to the survey, 83% reported that they feel it is appropriate for the ED physician to initiate controller medications.

Just 23% of pediatricians reported that their patients "almost always" follow-up within 1 month after an ED visit. Half (51%) of those surveyed believe that having ED physicians prescribe controller meds in the ED will encourage patients to follow-up, but 54% believe it could hinder follow-up, Dr. Sampayo noted.

The survey also asked the pediatricians what they consider to be the benefits of having ED physicians initiate asthma controller medications. Most (85%) feel that it is a "teachable moment" and represents an important opportunity to capture patients who are poorly controlled.

"The pediatricians felt that using the ED might encourage a family to be more likely to use a controller medication to avoid future ED visits. This is very important since many of these patients were not following up with their pediatrician," she said.

Most (79%) of those surveyed expected the ED physician to communicate with them. Slightly more than half (55%) reported receiving regular communication from the ED. The preferred methods of communication were medical record fax (59%), phone call (25%) and mailed chart (10%). In addition, 23% reported having access to an electronic medical record.

Now the task is to get the word out to ED physicians, Dr. Sampayo said.

"If the ED docs know that pediatricians approve of this practice and actually want us to do it, that might help us. If the pediatricians are saying that these kids are really not getting to them and they need us to do this, then I think we will," she said.

Dr. Noah Kondamudi

Noah Kondamudi, MD, an asthma specialist in the Pediatric Emergency Department of the University of Medicine & Dentistry of New Jersey in Newark, said that in his experience, more and more ED doctors are prescribing asthma controller medications when children present with acute asthma.

"I go to a lot of emergency medicine meetings, and I see more and more emergency room physicians who are starting controller medications in the ED, based upon previous data that show that the primary care doctor is willing to continue what we prescribe," Dr. Kondamudi, who was not part of the study, told Medscape Medical News.

"In general, emergency room doctors would not want to add to or change the primary care doctor's chronic disease plan. However, more and more data are showing that many asthmatic children are not on controller medication, so initiating controller therapy should make a big difference," he said.

Dr. Sampayo and Dr. Kondamudi have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition: Abstract 14793. Presented October 14, 2011.

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