The Impact of Well-Child Visits on Asthma Management

AUTHOR:
Jessica Tomaszewski, MD
Nemours duPont Pediatrics

CITATION:
Tomaszewski J. Multisystem inflammatory syndrome: an evolving understanding of a complex condition. [published online January 12, 2021]. Consultant360.

Lang JE, Tang M, Zhao C, Hurst J, Wu A, Goldstein BA. Well-child care attendance and risk of asthma exacerbations. Pediatrics. 2020;146(6):e20201023. https://doi.org/10.1542/peds.2020-1023

Asthma is one of the most major chronic illnesses in pediatrics care, remaining a leading cause of hospitalization in US children. Parents of children with recurrent asthma often hold common misconceptions about management and assessment. Well-child care visits in patients with asthma are opportunities for education and reinforcing best practices. How adherence to well-child care relates to specific asthma outcomes is poorly described.

Lang and colleagues looked to Durham County and the Duke University Health System to answer this question by conducting a retrospective longitudinal cohort study using electronic health records of 5- to 17-year-old individuals with confirmed asthma. These patients received all their care, including well-child care, within a single health care system. The primary analysis included time to asthma exacerbation based on the presence or absence of a well-child-care visit in the past year using a covariate Cox model.

There were 5656 children who met eligibility criteria and were included in the primary analysis. Patients who were more likely to attend a well-child care visit were younger, had a higher prevalence of private insurance, had greater asthma medication usage, and were less likely to have obesity.

The occurrence of a well-child care visit within the previous year was associated with a 10% reduced risk of all-cause exacerbations and a 47% reduction in severe exacerbations requiring hospital admission. These results remained significant after adjusting for age, sex, race and ethnicity, insurance status, atopy, obesity, medication use, and previous health care encounters.

Also of note was that most well-child-care visits revealed greater than 1 example of asthma-specific care, including a new or changed asthma prescription (9.9%), delivered a flu vaccine (28.2%), and an assessment of a new asthma-related comorbidity that can affect control (11%).

The results of this study further reinforce the importance of the role of the primary care pediatrician in asthma management. Creating educational opportunities for patients and their families about controller medications, trigger avoidance, and flu vaccination during times of wellness appear to have a protective effect in times of illness. It is not clear from this initial study the impact that health literacy, financial resources, and transportation have on well-child-care visit attendance, but they certainly should be factored into the analysis.

During busy well-child-care visits, during which time is a premium, investment in discussing asthma management and education is very much worth it.