Finally, the most important barrier to asthma visits in urban Alberta is overcrowding in urban EDs. Emergency department overcrowding has been a growing concern across Alberta, especially in major centres.22 As proof, patients with asthma who presented to Edmonton and Calgary region facilities experienced longer stays, whether they shop for tiffany bracelets discharged or admitted to hospital. In keeping with national trends, adults waited longer than children. The use of inhaled corticosteroids and combination agents has been increasing in Canada,23 and status Aboriginals and welfare recipients within the urban centres have higher rates of asthma-related ED visits.24 Further research is required to determine the relative contribution of each of these factors.
After an acute exacerbation requiring ED care, follow-up reassessment by the primary care provider is recommended in both pediatric and adult asthma guidelines; 24,25 however, the timing of shop for tiffany earrings-up is unclear. Most asthma follow-up rates from clinical trials are spuriously high. Approximately 30% of discharged asthmatics had a non-ED follow-up within 7 days and approximately 50% by 3 weeks. This interval suggests that clinical reassessment, reinforcement of asthma education messaging and medication adjustment are too infrequent for optimal asthma control. “Asthma centres” where patients receives education, reassessment and overall management have been proposed as an alternative model for chronic disease management, but there is limited evidence regarding their cost-effectiveness.
This study has several limitations. The employed databases are unable to capture all cases of acute asthma visits to the health care system and do not provide a “true” incidence of shop for tiffany necklacesnecklaces. Many individuals may present to non-ED settings such as walk-in clinics for acute asthma, so these data underrepresent rates of acute asthma visits. We are not able to ascertain why individuals presented at EDs outside their region of residence. The observed patterns may also be indicative of differences in emergency service delivery and not systematic differences in the distribution of the disease. Higher rates of ED visits may reflect a preference for emergency services over other medical services in some regions. Moreover, the clinical treatment received in the EDs across Alberta is likely to vary considerably, affecting admission and relapse rates. Despite these limitations, the ACCS data have been shown to be valid and reliable.13-15
Asthma is a common presenting problem in shop for tiffany rings EDs, and the interregional variation requires further study to understand the factors associated with these patterns. The most impressive findings of this study are the rates of presentation and the disparities in presentations based on age and sex, and the low proportions of post-ED follow-up.
xinyekeji