Figure 3 shows a breakdown of exacerbation types. Thirteen patients were readmitted with asthma exacerbations in the 6 months, resulting in 17 readmissions to the hospital, 12 in the doctor group and 5 in the nurse group. There was no significant difference in the number of patients readmitted between the groups (p = 0.336). The mean number of hospital readmissions per patient was 0.07 in the nurse group (5 readmissions in 68 patients) and 0.18 in the doctor group (12 readmissions in 65 patients). Using Pois-son regression, the relative risk of readmission was 0.40 (95% CI, 0.14 to 1.12; p = 0.09). Emergency nebulization, defined as the use of rescue nebulization in accident and emergency departments, general practice, or by ambulance paramedics, was required 35 times (for 17 different patients) in the nurse group, compared to 16 times (for 10 different patients) in the doctor group. canadian healthcare mall
To examine this further, we compared those patients who required any form of emergency treatment (hospital admission or emergency nebulization) for the exacerbation; this totaled 30 patients. The mean number of exacerbations per patient requiring emergency treatment was 0.59 in the nurse group and 0.43 in the doctor group. From Poisson regression, the relative risk of requirement for emergency treatment was 1.37 (95% CI, 0.84 to 2.21), demonstrating no significant difference between the groups. We also considered exacerbations requiring an additional intervention (all those except an increase in inhaled corticosteroids, for instance IV or oral steroids). Fifty-two patients required an additional intervention during an exacerbation, 27 patients (51.9%) in the nurse group and 25 patients (48.1%) in the doctor group (p = 0.572). The mean number of exacerbations requiring additional treatment per patient was 1.18 in the nurse group compared to 0.91 in the doctor group (relative risk, 1.30; 95% CI, 0.93 to 1.81).
Only 52 patients in the doctor group and 49 patients in the nurse group completed the quality of life questionnaires. The remaining participants declined to complete the final 6-month questionnaires despite reminders being sent. In the AQ20, there was a mean drop of 0.47 (SD 3.73) in the nurse group, compared to a 0.31 increase (SD 3.53) in the doctor group in the 6-month period. The difference, 0.78 (95% CI, -0.64 to 2.19), was not significant (p = 0.285). There was a mean improvement in the SGRQ score of 3.94% (SD 14.34) in the nurse group, compared with an improvement of 5.02% (SD 16.43) in the doctor group. This difference of 1.08 (95% CI, – 5.0 to 7.2) was not significant (p = 0.727). Each of the three components of the SGRQ (symptoms, activity, and impacts) were also assessed individually in this way, and no differences were found.
Figure 3. The number of patient exacerbations according to type.