Background: Patients with a history of asthma-related hospitalizations are at high risk of readmission and generally consume a large amount of health-care resources. It is not clear if the secondary care provided by specialists after an episode of asthma-related hospitalization is associated with better outcomes compared with the primary care provided by general practitioners.

Methods: Using population-based administrative health Australia Pharmacy online data from the province of British Columbia, Canada, we created a propensity-score-matched cohort of individuals who received primary vs secondary care in the 60 days after discharge from asthma-related hospitalization. Total direct asthma-related medical costs (primary outcome) and health service use and measures of medication adherence (secondary outcomes) were compared for the next 12 months.

Results: Two thousand eighty-eight individuals were equally matched between the primary and secondary care groups. There was no difference in the direct asthma-related costs (difference $567; 95% CI, —$276 to $1,410) and rate of readmission (rate ratio [RR] = 1.06; 95% CI, 0.85-1.32) between the secondary and the primary care groups. Patients under secondary care had a higher rate of asthma-related outpatient service use (RR = 1.22; 95% CI, 1.11-1.35) but a lower rate of shortacting p-agonist dispensation (RR = 0.91; 95% CI, 0.85-0.98). The proportion of days covered with a controller medication in Canadian Pharmacy Generic was higher among the secondary care group (difference of 3.2%; 95% CI, 0.4%-6.0%).

Conclusions: Compared with those who received only primary care, patients who received secondary care showed evidence of more appropriate treatment. Nevertheless, there were no differences in the costs or the risk of readmission. Adherence to asthma medication in both groups was poor, indicating the need for raising the quality of care provided by generalists and specialists alike.

One of the investigators (SS) made daily rounds in the medical ICU to identify eligible patients. Patients who were entered into the study were prospectively followed up until they were discharged from the hospital or had died. Discharge from the hospital was defined as patient transfer from the hospital to home, to a skilled nursing facility, or to a private rehabilitative hospital. All patients suspected of having a microbiologically confirmed infection were prospectively and independently reviewed by a board-certified infectious disease physician (VJF) to confirm the diagnosis and the adequacy of the prescribed antimicrobial therapy using the criteria described below. Patients could not be entered into the study more than once during the same hospitalization.

All definitions were selected prospectively as part of the original study design. We calculated APACHE II scores on the basis of the clinical data available from the first 24-h period of intensive care. Canadian viagra shop The definition used for severe sepsis was the one proposed by the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. The Organ System Failure Index was modified from that used by Rubin and coworkers. One point was given for acquired dysfunction of each organ system. Renal dysfunction was defined as a twofold increase in baseline creatinine level or an absolute increase in baseline creatinine level of 176.8 pmol/L (ie, 2.0 mg/dL). Hepatic dysfunction Viagra pharmacy Canada was defined as an increase in total bilirubin level to > 34.2 pmol/L (ie, 2.0 mg/dL). Pulmonary dysfunction was defined as one of the following:

(1) a requirement for mechanical ventilation for a diagnosis of pneumonia, COPD, asthma, or pulmonary edema (cardiogenic or noncardiogenic);

(2) a Pao2 of < 60 mm Hg while receiving a fraction of inspired oxygen of > 0.50;

(3) the use of at least 10 cm H2O of positive end-expiratory pressure, hematologic dysfunction, the presence of disseminated intravascular coagulation, a leukocyte count of < 1,000 cells/pL (ie, 1.0 X 109 cells/L) or a platelet count of < 75 X 103 cells/pL (ie, 75 X 109 cells/L), neurologic dysfunction, a new focal deficit (eg, hemiparesis after cerebral infarction) or a new generalized process (eg, seizures or coma), GI dysfunction, GI hemorrhage requiring transfusion, or new ileus or diarrhea lasting for > 24 h and unrelated to previous bowel surgery. Cardiac dysfunction was defined as acute myocardial infarction, cardiac arrest, or the new onset of congestive heart failure.

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