The outcome of right-siting asthma patients to primary care providers

Lai Mei Tham, Lathy Prabhakran, Albert Yick Hou Lim, Bing Sun

Abstract


Right-siting chronic asthma care from acute care hospitals to primary care providers (PCPs) was an initiative undertaken at an institution in Singapore. This study aimed to evaluate the effectiveness of right-sitingasthma patients from three different clinical settings. A retrospective study was conducted from January 2012 to December 2012. A total of 460 patients were right-sited to primary care providers (PCP). Of these, 392 (85.2%) were decanted to polyclinics and 68 (14.8%) to general practice (GP) settings. The asthma control test scores were significantly improved for patients who were followed up at the polyclinic within 12 months after being right-sited to the PCP (p<0 .001). Out-patients had lower emergency department (ED) re-attendance rates compared to other referral sources (p<0.001) and in-patients had higher re-admission rates than other referral sources (p=0.002). Re-admission patients had a statistically significantly higher mean age of 55 than non-re-admission patients at 44 (p < .001). Patients with prior ED attendance and hospitalization had higher rates of re-attendance and re-admission within a year (p= 0.001, p<0.001).The risk of ED patients experiencing re-attendance at the ED within 12 months was 5 times that of out-patients (p<0.001). In conclusion, the employment of a right-siting coordinator (RSO) did provide better transition for patient care between acute hospital settings and PCPs. Although the single intervention of connecting patients to their PCPs with an appointment prior to discharge did not significantly improve patient compliance to follow-up care, it did appear to improve asthma control in patients who kept to their PCP appointments suggesting that PCP follow-up is effective in the improvement of long-term preventative care.


Keywords


Asthma, right-siting, primary care provider, health care utilization

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References


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