When we tried to obtain information from patients about why they did not attend their scheduled educational interventions, we got only a limited number of responses, with most patients being difficult to contact for a response. Therefore, this aspect could not be evaluated properly.
Motivation of Patients and Their Families To Take Part in the Educational Program
There were large variations between hospitals in the proportion of referrals to AECs. The proportion of subjects who agreed to make appointments was higher when the referrals came from site 3 (100%), and sites 2, 4, and 9 (73.1 to 77.0%).
More specifically, in site 6, 67.1% of referral subjects could not be contacted; in other centers, this proportion varied from 0 to 25.5%. Moreover, from this center, the percentage of patients who honored their appointments was particularly low (12.3%) compared with sites 3 and 9 (63.1% and 62.2%, respectively).
The main reason for the low success rate for site 6 appears to be a lack of motivation among the participants to make the program successful, although other unknown reasons may have played a role.
The simultaneous presence of multiple barriers to the implementation of the program (four of the six barriers previously mentioned) could as well explain this result.
In most centers, attempts were made to contact the patients who did not attend the program, but without success. Nevertheless, these patients had received a copy of available resources in case of future need, and this could have influenced their long-term outcome, although it would require further study to confirm this.
We propose a program whose goals are to provide basic training to ED staff and, with the agreement of the ED physician, to offer patients presenting for acute asthma automatic referral to an AEC.
Our analysis shows a high rate of acceptance of, and significant interest in such a program among ED caregivers, as determined from participants’ reports and the marked increase in AEC referrals. We also documented some barriers to the implementation of such a program.