Factors associated with hospital admissions and repeat emergency department visits for adults with asthma

Background-A small proportion of patients with asthma account for a disprop ortionate number of acute health service events. To identify whether factor s other than severity and low socioeconomic status were associated with thi s disproportionate use, a prospective study was undertaken to examine manag ement and psychosocial factors associated with increased risk for admission to hospital with asthma and repeat visits to the emergency department over a 12 month period. Methods-A total of 293 patients with moderate or severe asthma managed at l east in part at two teaching hospitals completed surveys of clinical status , acute events, sociodemographic, and psychological variables. Results-Twenty three percent had a single admission to hospital and 16% had two or more hospital admissions. Twenty six percent had one emergency depa rtment visit and 32% had two or more visits to the emergency department. In a multiple logistic regression model, adjusted for age, sex, education and income, odds ratios (95% CI) for baseline factors associated with hospital admissions over the next 12 months were: moderate severity compared with s evere asthma 0.6 (0.2 to 0.9); no hospital admissions in the past 12 months 0.1 (0.01 to 0.2); not possessing a written asthma action plan 4.0 (1.5 to 10.7); less use of an avoidance coping style 0.4 (0.3 to 0.7); lower prefe rences for autonomy in asthma management decisions 1.4 (0.96 to 2.0). Adjus ted odds ratios (95% CI) for repeat emergency department visits were: moder ate asthma severity 0.3 (0.1 to 0.8); current regular use of oral corticost eroids 10.0 (3.1 to 32.4); a hospital admission in the past 12 months 2.9 ( 1.8 to 4.8); not possessing a written asthma action plan 2.2 (1.1 to 5.6); less dislike of asthma medications 0.7 (0.5 to 0.9). Conclusions-In addition to factors relating to severity, not possessing a w ritten asthma action plan, avoidance coping, and attitudes to self-manageme nt were related to acute use of health services in this at risk group. Inte rventions need to address or take these factors into account to reduce asth ma morbidity.