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Compliance With National Asthma Management Guidelines and Specialty Care

TL;DR: In this article, the authors found that adherence to NAEP guidelines was poor, and only 26% of respondents reported using a flow meter daily, while only 16% used inhaled steroids.
Abstract: In general, adherence to NAEP guidelines waspoor. Seventy-two percent of respondents with severeasthmareportedhavingasteroidinhaler,andofthose,only54% used it daily. Only 26% of respondents reported hav-ingapeakflowmeter,andofthose,only16%useditdaily.Age (older), duration of asthma (longer), increasing cur-rent severity of disease, and treatment by an asthma spe-cialist correlated with daily use of inhaled steroids. Eth-nicity(AfricanAmericanandHispanic)correlatednegativelywithinhaledsteroidusebutpositivelywithemergencyde-partment visits and hospital admissions for asthma. In-creasing age and treatment by an asthma specialist werealso identified as common factors significantly related tothedailyuseofapeakflowmeterand,interestingly,toover-use of b
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Journal ArticleDOI
TL;DR: The reliability and validity of the Asthma Control Test is evaluated in a longitudinal study of asthmatic patients new to the care of an asthma specialist, finding a cutoff score of 19 or less identifies patients with poorly controlled asthma.
Abstract: Background The development of the Asthma Control Test (ACT), a short, simple, patient-based tool for identifying patients with poorly controlled asthma, was recently described in patients under the routine care of an asthma specialist. Objectives We sought to evaluate the reliability and validity of the ACT in a longitudinal study of asthmatic patients new to the care of an asthma specialist. Methods Patients (n = 313) completed the ACT and the Asthma Control Questionnaire (ACQ) at 2 physician visits (4-12 weeks apart). Pulmonary function was measured, and asthma specialists rated asthma control. Results Internal consistency reliability of the ACT was 0.85 (baseline) and 0.79 (follow-up). Test-retest reliability was 0.77. Criterion validity was demonstrated by significant correlations between baseline ACT scores and baseline specialists' ratings of asthma control ( r = 0.52, P r = −0.89, P P r = 0.44, P r = −0.69, P 1 values ( r = 0.29, P Conclusions The ACT is reliable, valid, and responsive to changes in asthma control over time in patients new to the care of asthma specialists. A cutoff score of 19 or less identifies patients with poorly controlled asthma. Clinical implications In a clinical setting the ACT should be a useful tool to help physicians identify patients with uncontrolled asthma and facilitate their ability to follow patients' progress with treatment.

1,062 citations

Journal ArticleDOI
TL;DR: In this article, the authors assessed the current levels of asthma control as reported by patients, which partly reflect the extent to which guideline recommendations are implemented, and found that patients' perception of asthma management is different from their actual asthma control.
Abstract: Asthma management guidelines provide recommendations for the optimum control of asthma. This survey assessed the current levels of asthma control as reported by patients, which partly reflect the extent to which guideline recommendations are implemented. Current asthma patients were identified by telephone by screening 73,880 households in seven European countries. Designated respondents were interviewed on healthcare utilization, symptom severity, activity limitations and asthma control. Current asthma patients were identified in 3,488 households, and 2,803 patients (80.4%) completed the survey. Forty-six per cent of patients reported daytime symptoms and 30% reported asthma-related sleep disturbances, at least once a week. In the past 12 months, 25% of patients reported an unscheduled urgent care visit, 10% reported one or more emergency room visits and 7% reported overnight hospitalization due to asthma. In the past 4 weeks, more patients had used prescription quick-relief medication (63%) than inhaled corticosteroids (23%). Patient perception of asthma control did not match their symptom severity; approximately 50% of patients reporting severe persistent symptoms also considered their asthma to be completely or well controlled. The current level of asthma control in Europe falls far short of the goals for long-term asthma management. Patients' perception of asthma control is different from their actual asthma control.

999 citations

Journal ArticleDOI
TL;DR: Patients with asthma who received education and long-term medication therapy management services achieved and maintained significant improvements and had significantly decreased overall asthma-related costs despite increased medication costs that resulted from increased use.
Abstract: Objective: To assess clinical, humanistic, and economic outcomes of a community-based medication therapy management (MTM) program for 207 adult patients with asthma over 5 years. Design: Quasi-experimental, longitudinal pre‐post study. Setting: 12 pharmacy locations in Asheville, N.C. Patients/Other Participants: Patients with asthma covered by two selfinsured health plans; professional educator at Mission Hospitals; 18 certificatetrained community and hospital pharmacists. Interventions: Education by a certified asthma educator; regular long-term follow-up by pharmacists (reimbursed for MTM by health plans) using scheduled consultations, monitoring, and recommendations to physicians. Main Outcome Measures: Changes in forced expiratory volume in 1 second (FEV 1 ), asthma severity, symptom frequency, the degree to which asthma affected people’s lives, presence of an asthma action plan, asthma-related emergency department/hospital events, and changes in asthma-related costs over time. Results: All objective and subjective measures of asthma control improved and were sustained for as long as 5 years. FEV 1 and severity classification improved significantly. The proportion of patients with asthma action plans increased from 63% to 99%. Patients with emergency department visits decreased from 9.9% to 1.3%, and hospitalizations from 4.0% to 1.9%. Spending on asthma medications increased; however, asthma-related medical claims decreased and total asthma-related costs were significantly lower than the projections based on the study population’s historical trends. Direct cost savings averaged $725/patient/year, and indirect cost savings were estimated to be $1,230/patient/year. Indirect costs due to missed/nonproductive workdays decreased from 10.8 days/year to 2.6 days/year. Patients were six times less likely to have an emergency department/hospitalization event after program interventions. Conclusion: Patients with asthma who received education and long-term medication therapy management services achieved and maintained significant improvements and had significantly decreased overall asthma-related costs despite increased medication costs that resulted from increased use.

326 citations

Journal ArticleDOI
TL;DR: A targeted text message programme targeted at changing patients’ illness and medication beliefs would improve adherence in young adult asthma patients and may be useful for other illnesses where adherence is a major issue.
Abstract: Objective. While effective preventative medication is readily available for asthma, adherence is a major problem due to patients’ beliefs about their illness and medication. We investigated whether a text message programme targeted at changing patients’ illness and medication beliefs would improve adherence in young adult asthma patients. Methods. Two hundred and sixteen patients aged between 16 and 45 on asthma preventer medication were recruited from pamphlets dispensed with medication and e-mails sent to members of a targeted marketing website. Participants were randomized to receive individually tailored text messages based on their illness and medication beliefs over 18 weeks or no text messages. Illness and medication beliefs were assessed at baseline and at 18 weeks. Adherence rates were assessed by phone calls to participants at 6, 12, and 18 weeks and at 6 and 9 months. Results. At 18 weeks, the intervention group had increased their perceived necessity of preventer medication, increased their belief in the long-term nature of their asthma, and their perceived control over their asthma relative to control group (all p's < .05). The intervention group also significantly improved adherence over the follow-up period compared to the control group with a relative average increase in adherence over the follow-up period of 10% (p < .001). The percentage taking over 80% of prescribed inhaler doses was 23.9% in the control group compared to 37.7% in the intervention group (p < .05). Conclusion. A targeted text message programme increases adherence to asthma preventer inhaler and may be useful for other illnesses where adherence is a major issue.

307 citations

Journal ArticleDOI
TL;DR: Current levels of asthma control in the Asia-Pacific region fall markedly short of goals specified in international guidelines for asthma management.
Abstract: Background: Few data on asthma management are available for the Asia-Pacific region. Objective: This study examined asthma symptoms, health care use, and management in the Asia-Pacific region. Methods: We performed a cross-sectional survey, followed by administration of a questionnaire in a face-to-face setting in the respondents' homes in their language of choice. Urban centers in 8 areas were surveyed: China, Hong Kong, Korea, Malaysia, The Philippines, Singapore, Taiwan, and Vietnam. Results: A population sample of 3207 respondents with physician-diagnosed asthma was identified by screening 108,360 households. Daytime asthma symptoms were reported by 51.4% of respondents, and 44.3% reported sleep disturbance caused by asthma in the preceding 4 weeks. At least 2 in every 5 respondents (43.6%) had been hospitalized, attended a hospital emergency department, or made unscheduled emergency visits to other health care facilities for treatment of asthma during the previous 12 months. Overall, 15.3% of respondents reported that they had required admission to the hospital for asthma treatment. Asthma severity correlated with the frequencies of hospitalizations and emergency visits for asthma in the past year. Even in those patients with severe persistent asthma, 34.3% regarded their disease as being well or completely controlled. Current use of an inhaled corticosteroid was reported by only 13.6% of respondents, and 56.3% used quick-relief bronchodilators. Absence from school and work in the past year was reported by 36.5% of children and 26.5% of adults. Conclusion: As reported for other regions, current levels of asthma control in the Asia-Pacific region fall markedly short of goals specified in international guidelines for asthma management. (J Allergy Clin Immunol 2003;111:263-8.)

302 citations

References
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Book
01 Jan 1989
TL;DR: Hosmer and Lemeshow as discussed by the authors provide an accessible introduction to the logistic regression model while incorporating advances of the last decade, including a variety of software packages for the analysis of data sets.
Abstract: From the reviews of the First Edition. "An interesting, useful, and well-written book on logistic regression models... Hosmer and Lemeshow have used very little mathematics, have presented difficult concepts heuristically and through illustrative examples, and have included references."- Choice "Well written, clearly organized, and comprehensive... the authors carefully walk the reader through the estimation of interpretation of coefficients from a wide variety of logistic regression models . . . their careful explication of the quantitative re-expression of coefficients from these various models is excellent." - Contemporary Sociology "An extremely well-written book that will certainly prove an invaluable acquisition to the practicing statistician who finds other literature on analysis of discrete data hard to follow or heavily theoretical."-The Statistician In this revised and updated edition of their popular book, David Hosmer and Stanley Lemeshow continue to provide an amazingly accessible introduction to the logistic regression model while incorporating advances of the last decade, including a variety of software packages for the analysis of data sets. Hosmer and Lemeshow extend the discussion from biostatistics and epidemiology to cutting-edge applications in data mining and machine learning, guiding readers step-by-step through the use of modeling techniques for dichotomous data in diverse fields. Ample new topics and expanded discussions of existing material are accompanied by a wealth of real-world examples-with extensive data sets available over the Internet.

35,847 citations

Journal ArticleDOI
TL;DR: Applied Logistic Regression, Third Edition provides an easily accessible introduction to the logistic regression model and highlights the power of this model by examining the relationship between a dichotomous outcome and a set of covariables.
Abstract: \"A new edition of the definitive guide to logistic regression modeling for health science and other applicationsThis thoroughly expanded Third Edition provides an easily accessible introduction to the logistic regression (LR) model and highlights the power of this model by examining the relationship between a dichotomous outcome and a set of covariables. Applied Logistic Regression, Third Edition emphasizes applications in the health sciences and handpicks topics that best suit the use of modern statistical software. The book provides readers with state-of-the-art techniques for building, interpreting, and assessing the performance of LR models. New and updated features include: A chapter on the analysis of correlated outcome data. A wealth of additional material for topics ranging from Bayesian methods to assessing model fit Rich data sets from real-world studies that demonstrate each method under discussion. Detailed examples and interpretation of the presented results as well as exercises throughout Applied Logistic Regression, Third Edition is a must-have guide for professionals and researchers who need to model nominal or ordinal scaled outcome variables in public health, medicine, and the social sciences as well as a wide range of other fields and disciplines\"--

30,190 citations

Book
01 Jan 1979

8,143 citations