A recent study evaluated recent years’ rendered patient care in emergency departments for patients with asthma exacerbations in comparison with data obtained from over 15 years ago, and revealed a number of notable inconsistencies in compliance with national-level asthma management guidelines. Co-author Dr. Kohei Hasegawa, MPH from Massachusetts General Hospital stated in a recent press release that despite asthma being one of the most prevalent respiratory problems in America, health practitioners and facilities are less stringent with following proper management guidelines compared to when dealing with cases like pneumonia and heart attacks. The study is published online in the Journal of Allergy and Clinical Immunology.
“We found that while emergency asthma care has become highly concordant with those guideline recommendations that are supported by strong scientific evidence, concordance with guideline-recommended care supported by weaker evidence declined,” said Dr. Hasegawa. “Our observations should encourage studies building more robust evidence for the latter.”
The study gathered data from 3 past investigations conducted by the Multicenter Airway Research Collaboration, under the Emergency Medicine Network. These investigations contained information on administered treatments for acute asthma in 48 hospitals in the US between the years 1997 and 2001, which were compared with more recent data from 2011 to 2012. Interventions were then evaluated according to the standards set by the National Institutes of Health in 2007. The written NIH guidelines have letter rankings based on the amount of supporting evidence, with Level A supported by the most groundbreaking studies and clinical trials.
The researchers noted that compliance with Level A guidelines improved over time. These covered the administration of medications according to accurate assessment of symptoms. Unfortunately, the same was not observed in lower-level guidelines such as in determining pulmonary function and promptness of care. The lack of compliance outweighed whatever improved in Level A guidelines. Additionally, they were able to note that patients who received treatment according to all levels of guidelines were less likely to return to the hospital for another acute asthma attack.
Dr. Hasegawa explains that they also noted differing compliance levels among the sampled emergency departments, and attributes it to possible overcrowding in the ER and triage limitations, which force staff to focus on interventions that can provide certain and more immediate relief. Future studies and evaluations should look into patient crowding as a potential factor in lack of compliance to set standards of care.
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