Pediatric - Prescription habits for preventative medications among pediatric emergency department physicians at an inner-city teaching hospital

S. Lovinsky, Deepa Rastogi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction. As asthma presentation is episodic, patients with acute exacerbations often present in the emergency department (ED) where preventative regimen may not always be addressed. Addressing initiation and modification of controller medications in the setting of an acute exacerbation may facilitate improved asthma control and decrease the frequency of ED visits, particularly so for families who receive most of their asthma management in the ED. However, this aspect has not yet been explored. Methods. We reviewed a random sample of 363 charts, 10% of the total number of asthmatic children, aged 2-18, seen from January to December 2007 in the pediatric ED of an urban teaching hospital located in Bronx, NY, USA. We quantified the frequency of modification of the preventative regimen and the influence of seasons on this practice. Results. Of these 363 children, 42.4% of patients were not previously on a controller medication. Of these, 9.7% were started on a new controller medication, with a significantly higher percent occurring in the summer months. Of those that were previously on a controller medication, 2.87% were started on a new controller medication and 0.95 had their controller medication dose increased. However, the regimen was not adjusted in 14.3% that had been seen four or more times in the preceding 2 years. Of the total 363 children, 78.5% were discharged from the ED on a short course of oral steroids, and this was not part of their preventative regimen. Only four charts had physician-documented asthma severity classification. Conclusions. We found that the preventative regimen was modified in only 0.9-2% of all asthmatic children seen in an urban ED whereas 78.5% were started on systemic steroids. Asthma severity was evaluated in a very small number of patients. Because modification of preventative regimen requires appropriate asthma severity classification, the inclusion of asthma severity classification as part of routine ED evaluation may encourage physicians to address controller medications in persistent asthmatics.

Original languageEnglish (US)
Pages (from-to)1011-1014
Number of pages4
JournalJournal of Asthma
Volume47
Issue number9
DOIs
StatePublished - Nov 2010

Fingerprint

Urban Hospitals
Teaching Hospitals
Habits
Prescriptions
Hospital Emergency Service
Asthma
Pediatrics
Physicians
Steroids

Keywords

  • asthma
  • controller medications
  • pediatric emergency department

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Immunology and Allergy
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

@article{d4f8334e850147f8b66622aca28f8547,
title = "Pediatric - Prescription habits for preventative medications among pediatric emergency department physicians at an inner-city teaching hospital",
abstract = "Introduction. As asthma presentation is episodic, patients with acute exacerbations often present in the emergency department (ED) where preventative regimen may not always be addressed. Addressing initiation and modification of controller medications in the setting of an acute exacerbation may facilitate improved asthma control and decrease the frequency of ED visits, particularly so for families who receive most of their asthma management in the ED. However, this aspect has not yet been explored. Methods. We reviewed a random sample of 363 charts, 10{\%} of the total number of asthmatic children, aged 2-18, seen from January to December 2007 in the pediatric ED of an urban teaching hospital located in Bronx, NY, USA. We quantified the frequency of modification of the preventative regimen and the influence of seasons on this practice. Results. Of these 363 children, 42.4{\%} of patients were not previously on a controller medication. Of these, 9.7{\%} were started on a new controller medication, with a significantly higher percent occurring in the summer months. Of those that were previously on a controller medication, 2.87{\%} were started on a new controller medication and 0.95 had their controller medication dose increased. However, the regimen was not adjusted in 14.3{\%} that had been seen four or more times in the preceding 2 years. Of the total 363 children, 78.5{\%} were discharged from the ED on a short course of oral steroids, and this was not part of their preventative regimen. Only four charts had physician-documented asthma severity classification. Conclusions. We found that the preventative regimen was modified in only 0.9-2{\%} of all asthmatic children seen in an urban ED whereas 78.5{\%} were started on systemic steroids. Asthma severity was evaluated in a very small number of patients. Because modification of preventative regimen requires appropriate asthma severity classification, the inclusion of asthma severity classification as part of routine ED evaluation may encourage physicians to address controller medications in persistent asthmatics.",
keywords = "asthma, controller medications, pediatric emergency department",
author = "S. Lovinsky and Deepa Rastogi",
year = "2010",
month = "11",
doi = "10.1080/02770903.2010.491138",
language = "English (US)",
volume = "47",
pages = "1011--1014",
journal = "Journal of Asthma",
issn = "0277-0903",
publisher = "Informa Healthcare",
number = "9",

}

TY - JOUR

T1 - Pediatric - Prescription habits for preventative medications among pediatric emergency department physicians at an inner-city teaching hospital

AU - Lovinsky, S.

AU - Rastogi, Deepa

PY - 2010/11

Y1 - 2010/11

N2 - Introduction. As asthma presentation is episodic, patients with acute exacerbations often present in the emergency department (ED) where preventative regimen may not always be addressed. Addressing initiation and modification of controller medications in the setting of an acute exacerbation may facilitate improved asthma control and decrease the frequency of ED visits, particularly so for families who receive most of their asthma management in the ED. However, this aspect has not yet been explored. Methods. We reviewed a random sample of 363 charts, 10% of the total number of asthmatic children, aged 2-18, seen from January to December 2007 in the pediatric ED of an urban teaching hospital located in Bronx, NY, USA. We quantified the frequency of modification of the preventative regimen and the influence of seasons on this practice. Results. Of these 363 children, 42.4% of patients were not previously on a controller medication. Of these, 9.7% were started on a new controller medication, with a significantly higher percent occurring in the summer months. Of those that were previously on a controller medication, 2.87% were started on a new controller medication and 0.95 had their controller medication dose increased. However, the regimen was not adjusted in 14.3% that had been seen four or more times in the preceding 2 years. Of the total 363 children, 78.5% were discharged from the ED on a short course of oral steroids, and this was not part of their preventative regimen. Only four charts had physician-documented asthma severity classification. Conclusions. We found that the preventative regimen was modified in only 0.9-2% of all asthmatic children seen in an urban ED whereas 78.5% were started on systemic steroids. Asthma severity was evaluated in a very small number of patients. Because modification of preventative regimen requires appropriate asthma severity classification, the inclusion of asthma severity classification as part of routine ED evaluation may encourage physicians to address controller medications in persistent asthmatics.

AB - Introduction. As asthma presentation is episodic, patients with acute exacerbations often present in the emergency department (ED) where preventative regimen may not always be addressed. Addressing initiation and modification of controller medications in the setting of an acute exacerbation may facilitate improved asthma control and decrease the frequency of ED visits, particularly so for families who receive most of their asthma management in the ED. However, this aspect has not yet been explored. Methods. We reviewed a random sample of 363 charts, 10% of the total number of asthmatic children, aged 2-18, seen from January to December 2007 in the pediatric ED of an urban teaching hospital located in Bronx, NY, USA. We quantified the frequency of modification of the preventative regimen and the influence of seasons on this practice. Results. Of these 363 children, 42.4% of patients were not previously on a controller medication. Of these, 9.7% were started on a new controller medication, with a significantly higher percent occurring in the summer months. Of those that were previously on a controller medication, 2.87% were started on a new controller medication and 0.95 had their controller medication dose increased. However, the regimen was not adjusted in 14.3% that had been seen four or more times in the preceding 2 years. Of the total 363 children, 78.5% were discharged from the ED on a short course of oral steroids, and this was not part of their preventative regimen. Only four charts had physician-documented asthma severity classification. Conclusions. We found that the preventative regimen was modified in only 0.9-2% of all asthmatic children seen in an urban ED whereas 78.5% were started on systemic steroids. Asthma severity was evaluated in a very small number of patients. Because modification of preventative regimen requires appropriate asthma severity classification, the inclusion of asthma severity classification as part of routine ED evaluation may encourage physicians to address controller medications in persistent asthmatics.

KW - asthma

KW - controller medications

KW - pediatric emergency department

UR - http://www.scopus.com/inward/record.url?scp=78149448820&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78149448820&partnerID=8YFLogxK

U2 - 10.1080/02770903.2010.491138

DO - 10.1080/02770903.2010.491138

M3 - Article

VL - 47

SP - 1011

EP - 1014

JO - Journal of Asthma

JF - Journal of Asthma

SN - 0277-0903

IS - 9

ER -