Presentation on theme: "Predictors of defaulters at a Fast Track Asthma Clinic LATHY PRABHAKARAN *, Earnest A**, Abisheganaden J*** Department of Nursing*, Clinical Research Unit**"— Presentation transcript:
Predictors of defaulters at a Fast Track Asthma Clinic LATHY PRABHAKARAN *, Earnest A**, Abisheganaden J*** Department of Nursing*, Clinical Research Unit** & Respiratory Medicine*** Tan Tock Seng Hospital, Singapore The Emergency department ED is increasingly used as a primary care facility for the treatment of asthma. Many of these high cost patients repeatedly return to ED for urgent asthma care despite referral to their primary care or outpatient clinic. Hence there was a need to reduce the burden of asthma related ED visits and it was a specific problem targeted for reductions in 2004 in Tan Tock Seng Hospital. Fast track asthma clinic (FTC) was initiated in August 2004 for patients seen at ED with poor asthma control to be fast track (expedited) to this clinic to be reviewed by the doctor. AT FTC patients are reviewed within two weeks instead of waiting for appointment at respiratory specialist clinic. The current waiting time at respiratory specialist clinic is seven weeks. Purpose of FTC –To stabilize and optimize asthma control –To reduce frequency of acute episodes –To reduce health resource utilization –To improve patient satisfaction –To reduce number of asthma cases seen at ED Despite the well-intended intervention of developing the fast track asthma clinic the default rates as been high. Background To predict the characteristics of patient who default fast track asthma clinic Patients who were given appointment to the Asthma Fast Track Clinic from April to August 2007 were used in our analysis. The exclusion criteria were: –wrong diagnosis referred to FTC –Referral from other sources other then ED and EDTC (24 hours treatment centre at ED) Data analyzed included demographic characteristics such as age, sex, ethnicity, source of referral, old cases of specialist clinic and 3 month prior ED attendance for acute asthma Statistical Analysis Data analysis was done in stataV 9.0. All test were conducted at the 5% level of significance. We compared difference in proportions using the chi- square test. For small samples we used the Fishers Exact Test. For cost data, which was not normally distributed, we used the Mann-Whitney Test to compare median cost, between those who showed / did not show. To compare between pre/post ED visit, we used the Wilcoxon Signed-rank test Cost of ED visit 3 month prior and post FTC appt MeanIQR 3 month prior ED visits$354$189-$581 3 month post ED visits$229$142-$484 Cost of ED visit 3 month post show rate and No show rate at FTC MeanIQR 3 month post NO Show rate$236$195-$459 3 month post Show rate$193$124-$636 Race was the only factor significantly associated with defaults rate (p= 0.022) Default rates were seen to be higher among the Indians and Other races. One limitation of this study is the small sample size. Power of study is low, with a large type 2 error. Statistical non-significance does not necessarily equate to clinical significance. This can be seen in large differences between groups but p-values are not significant. Reasons for non-attendance at the asthma clinic can be multifactorial. We need to find out patients perception of illness, psychosocial stressors, barriers to health care. It will then lead to better understanding of this high risk patient and offer appropriate treatment and care. We are in the process of doing a Clinical Practice Improvement Program (CPIP). To reduce the default rate of referral appointments from ED to the Fast Track asthma Clinic (FTC)* from the current 50% to less then 10% in 6 months The author would like to thank Ms Lee Lay Keng from finance department for her assistance. 1.Garrtt J E, Mulder J, and V. A, "Trends in the use of the our urban accident and emergency departments by asthmatics," NZ Med Journal, vol. 101, pp. 253-255, 1988. Aim Of Study Methodology Results Reference Acknowledgement Suggestion Discussion Costs Fig 1: Sex Distribution Total 135 Fig 2: Ethnicity Distribution Fig 3: Age Distribution Source of Referral to FTC Prior attendence to Specialist Respiratory Medicine Clinic Default Rates Frequency of ED visit 3 month prior and post FTC appointments
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