Boosting Referrals to Asthma Specialists for Patients Seen at the Emergency Room for an Asthma Exacerbation

N/ANot Yet RecruitingNCT07396987

Juan Carlos Cardet40 enrolled

Overview

This study is testing a new way to help adults with asthma get follow up care after an emergency room (ER) visit for an asthma attack. Many people who come to the ER for asthma never see an asthma specialist afterward, even though specialists can offer treatments such as advanced inhalers or biologic medicines that may prevent future attacks. The study will compare two approaches. One group will receive a telehealth appointment with an asthma specialist that is scheduled for them before they leave the ER. The other group will receive the usual care, which typically includes a standard referral but no scheduled appointment. All participants will be offered a prescription for standard controller medication at discharge. The main question the study aims to answer is whether arranging a telehealth visit directly from the ER increases the number of patients who complete a follow up appointment with an asthma specialist within three months. The study will also look at whether this approach improves asthma control, reduces repeat ER visits, and helps patients better understand and use their asthma medications. This research may help identify a practical way to improve access to asthma specialists and reduce the burden of asthma for patients who frequently rely on emergency care.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

Conditions

Asthma Attack Asthma Control

Interventions

ER-Initiated Telehealth ReferralBEHAVIORAL

Participants assigned to the intervention arm will receive an asthma specialist follow up appointment that is scheduled directly from the emergency department before discharge. Emergency department staff will contact the specialist clinic to arrange a telehealth visit within 1-3 weeks. The telehealth visit will address asthma symptoms, medication use, and follow-up care needs. All participants, including those in the intervention arm, will be offered a prescription for standard inhaled corticosteroid/long-acting beta-agonist controller therapy at discharge. The intervention focuses on improving access to specialist care through proactive scheduling and telehealth delivery.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥18 years * Asthma diagnosis ≥1 year * Seen in ER for asthma exacerbation * Persistent asthma on controller therapy * ≥1 asthma exacerbation in prior year We will allow for current smokers, vapers and cannabis users as long as they have not been diagnosed with COPD and have a smoking history \<10 pack-years. We will allow for COPD as long as they are: 1. never smokers/vapers/cannabis users; or 2. former or current smokers/vapers/cannabis users with normal pulmonary function tests (PFT; FEV1/FVC ratio of \>70%) within 12 months of enrollment and a smoking history \<10 pack-years; or 3. current or former smoker/vapers/cannabis users with obstruction on PFTs (FEV1/FVC ratio of \<70%) but who demonstrate BOTH \>10% acute bronchodilator reversibility AND a normal diffusing capacity both within 12 months of enrollment (stricter criteria than those used in the PREPARE trial (15) and a smoking history \<10 pack-years. Exclusion Criteria: * Patients who have seen an asthma specialist (allergist or pulmonologist) for asthma in the past 2 years * Diagnosis of other pulmonary diseases (e.g., COPD, interstitial lung disease, etc.)

Outcomes

Primary Outcomes

Proportion of Participants Completing an Asthma Specialist Follow-Up Visit Within 3 Months After Emergency Department Discharge

Completion of an asthma specialist follow-up visit will be assessed using documentation in the electronic health record. A visit will be counted if the record shows that the participant completed a telehealth or in-person appointment with an asthma specialist within 3 months after the emergency department discharge. The outcome will be reported as the proportion of participants in each study arm who completed a qualifying specialist visit during the 3-month follow-up period.