Moore C M, Ahmed I, Mouallem R, May W, Ehlayel M, Sorensen R U
Division of Allergy & Immunology, Louisiana State University Medical Center, New Orleans, USA.
Ann Allergy Asthma Immunol. 1997 Apr;78(4):373-80. doi: 10.1016/S1081-1206(10)63199-7.
Demographic and socioeconomic factors have an impact upon the morbidity and mortality rates of asthma in inner-city pediatric populations. Many pediatric patients with asthma use the emergency room as their primary care physician, while a smaller number of children with asthma use the allergy-immunology clinic.
We examined the demographic and socioeconomic characteristics of asthmatic patients using the emergency room as their primary care physician and of those attending the allergy-immunology clinic in the same inner-city hospital. We compared the morbidity and cost of care of asthmatic patients who received their medical care in the emergency room to that of those who received their care in the allergy-immunology clinic.
Fifty consecutive emergency room patients and 25 clinic patients were studied using an identical questionnaire.
There was no difference between the two groups in the total number of individuals per household, children per family, monthly income, type or size of dwelling, financial problems purchasing medications, health insurance type, distance to the medical center, or education of the caretaker. Severity of asthma was not different in the two groups before the start of the study. The only significant demographic difference was in age: 10.6 years for the clinic group and 7.8 years for the emergency room group (P < .002). Clinically, in the year preceding the interview, the clinic group had significantly less nocturnal cough (P < .025), sleep interruption (P < .001), weekly asthma (P < .05), and emergency room visits (P < .09). The allergy clinic group had an approximate average savings of $137 per patient per year. Hospital admissions and emergency room costs were increased by a small group of three allergy clinic patients, decreasing the difference in the cost of care between the two groups.
The data showed that patients who attended the emergency room and those who attended the allergy-immunology clinic were not demographically or socioeconomically different. The decreased morbidity of asthma and cost of care for the allergy clinic patients, as opposed to the emergency room patients, are likely due to the care given in the allergy-immunology clinic.
人口统计学和社会经济因素会对市中心儿科人群的哮喘发病率和死亡率产生影响。许多患有哮喘的儿科患者将急诊室作为他们的初级保健医生，而少数哮喘儿童会去过敏免疫诊所就诊。
我们研究了将急诊室作为初级保健医生的哮喘患者以及在同一市中心医院的过敏免疫诊所就诊的哮喘患者的人口统计学和社会经济特征。我们比较了在急诊室接受治疗的哮喘患者与在过敏免疫诊所接受治疗的哮喘患者的发病率和护理费用。
使用相同的问卷对50名连续的急诊室患者和25名诊所患者进行了研究。
两组在每户人数、每个家庭的孩子数量、月收入、住所类型或大小、购买药物的经济问题、医疗保险类型、到医疗中心的距离或看护人的教育程度方面没有差异。在研究开始前，两组哮喘的严重程度没有差异。唯一显著的人口统计学差异是年龄：诊所组为10.6岁，急诊室组为7.8岁（P <.002）。在临床上，在访谈前的一年中，诊所组的夜间咳嗽（P <.025）、睡眠中断（P <.001）、每周哮喘发作（P <.05）和急诊室就诊次数（P <.09）明显更少。过敏诊所组每位患者每年大约平均节省137美元。一小部分三名过敏诊所患者增加了住院和急诊室费用，缩小了两组护理费用的差异。
数据表明，在急诊室就诊的患者和在过敏免疫诊所就诊的患者在人口统计学或社会经济方面没有差异。与急诊室患者相比，过敏诊所患者哮喘发病率降低和护理费用降低，可能是由于过敏免疫诊所提供的护理。
