Predicting readmission to hospital with asthma

Objectives: To determine whether readmission to hospital for children aged 1-7 years with asthma can be predicted; and to discover whether factors rel ated to the severity of the attack and past pattern of asthma, assessment o f the parents' intention to treat the child with inhaled therapy, perceived consequences of treatment, habits of treatment and self-efficacy show a di fference between those children subsequently readmitted and those who were not. Methods: A specifically developed questionnaire was administered to parents of 121 children admitted with asthma. Clinical assessment was made of seve rity of the acute attack and past pattern of the asthma. One year after adm ission subjects were reviewed to determine those who had been readmitted. Results: On univariate analysis, the negative perceived consequences of tre atment with inhaled therapy were associated with an increased risk of readm ission over a one-year period (P = 0.04). After adjusting for confounders ( place of birth of mother, two- or one-parent family) and the effect-modifie r of past pattern of the asthma (infrequent episodic, frequent episodic, pe rsistent), the greater the negative perceived consequences of treatment, th e more likely there would be readmission in children with infrequent episod ic asthma. After adjusting for potential confounders, using logistic regres sion a decrease of one standard deviation in the negative perceived consequ ences score resulted in a one-third decrease in the odds of readmission (od ds ratio (OR)= 0.31, 95% CI 0.12-0.83). Conclusions: Parents whose children are readmitted see greater negative per ceived consequences of treatment, If asthma is infrequent episodic, the neg ative perceived consequences may be an inhibitor of treatment, whereas for more severe past patterns of asthma the severity is the controller of treat ment. If parental negative consequences could be decreased, admissions for asthma may decrease.