Management of asthma among community-based primary care physicians.
TL;DR: A gap in the provision of asthma education, written action plans, and spirometric testing for patients diagnosed with asthma among primary care physicians in Alberta is indicated.
Abstract: Background. Despite significant improvements in asthma treatment and the dissemination of national and international guidelines for asthma management, there are ongoing concerns that suboptimal care is being provided for patients with asthma. Objective. To determine the current practice patterns of asthma care among primary care physicians. Design. A cross-sectional study. Setting. Province of Alberta, Canada (population: 3 million people). Participants. Patients, 5 years of age or older, who had a physician's diagnosis of asthma, and had at least two visits for asthma between 1996 and 2001. Measurement and Results. Charts of 3072 distinct patients (from 45 unique primary care physicians) were reviewed. Previous emergency department visits or hospitalizations were experienced by 20% of the sample. A total of 25% of patients had documented evidence that they had performed spirometry. More than half of the patients had no documented evidence that they had received any form of asthma education; only 2% of th...
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TL;DR: Since the last major national survey, guideline implementation has not resulted in significant changes in asthma-related morbidity and effective means of knowledge transfer should be developed and implemented to improve the translation of guideline recommendations into care.
Abstract: BACKGROUND: Two Canadian studies showed that 55% of patients with asthma had daily symptoms (in 1996) and that 57% of patients suffered from poorly controlled asthma (in 1999).
211 citations
TL;DR: Knowing translation is a transformative concept that links the best elements of both broad fields and, in particular, adds educational elements to the work of health services researchers and others.
Abstract: This article discusses continuing education and the implementation of clinical practice guidelines or best evidence, quality improvement, and patient safety. Continuing education focuses on the perspective of the adult learner and is guided by well-established educational principles. In contrast, guideline implementation and related concepts borrow from the fields of quality improvement and patient safety and from health services research. Relative to the question of improved clinical outcomes, both to some extent afford only partial understanding of a complex issue. Knowledge translation (KT) is a transformative concept that links the best elements of both broad fields and, in particular, adds educational elements to the work of health services researchers and others. Interdisciplinary in the extreme, KT is explored in some detail: its major elements (information, facilitation, context, the clinician-learner, among others) considered as variables in an equation leading to knowledge uptake and improved health care outcomes and an improved functioning health care system.
100 citations
TL;DR: A dynamic, real-time, interactive, mobile health system with an integrated asthma action plan SPA can support knowledge translation at the patient and provider levels.
Abstract: BACKGROUND: Collaborative self-management is a core recommendation of national asthma guidelines; the written action plan is the knowledge tool that supports this objective. Mobile health technologies have the potential to enhance the effectiveness of the action plan as a knowledge translation tool.
74 citations
Cites background from "Management of asthma among communit..."
...However, outside of specialized asthma programming, there is a significant knowledge-to-action gap, with as few as 2% of asthmatic patients having a written action plan (13)....
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TL;DR: Register-based data on redeemed prescriptions can be utilised to identify asthmatic school children and will be useful in health services research and in the proactive care of astHmatic children.
Abstract: Objective
The aim of the study was to develop and validate a method for identifying asthmatic children between 6 and 14 years of age based on prescription data on anti-asthmatic drugs and diagnostic data.
72 citations
TL;DR: The use of preventive medications among children with persistent asthma was described to determine whether children using preventive medications have adequate asthma control, and factors associated with poor control were identified.
63 citations
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TL;DR: Recent data suggest that the burden from childhood asthma may have recently plateaued after several years of increasing, although additional years of data collection are necessary to confirm a change in trend.
Abstract: Objectives. Our objective was to use national data to produce a comprehensive description of trends in childhood asthma prevalence, health care utilization, and mortality to assess changes in the disease burden among US children. Methods. Five data sources from the National Center for Health Statistics were used to describe trends in asthma for children aged 0 to 17 years from 1980 to the most recent year for which data were available. These included the National Health Interview Survey (NHIS), the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the Mortality Component of the National Vital Statistics System. Results. Asthma prevalence increased by an average of 4.3% per year from 1980 to 1996, from 3.6% to 6.2%. The peak prevalence was 7.5% in 1995. In 1997, asthma attack prevalence was 5.4%, but changes in the NHIS design in 1997 preclude comparison to previous estimates. Asthma attack prevalence remained level from 1997 to 2000. After a decrease between 1980 and 1989, the asthma office visit rate increased by an average of 3.8% per year from 1989 to 1999. The asthma hospitalization rate grew by 1.4% per year from 1980 to 1999. Although childhood asthma deaths are rare, the asthma death rate increased by 3.4% per year from 1980 to 1998. Children aged 0 to 4 years had the largest increase in prevalence and had greater health care use, but adolescents had the highest mortality. The asthma burden was borne disproportionately by black children throughout the period. Racial disparities were largest for asthma hospitalizations and mortality: compared with white children, in 1998–1999, black children were >3 times as likely to be hospitalized and in 1997–1998 >4 times as likely to die from asthma. Conclusions. Recent data suggest that the burden from childhood asthma may have recently plateaued after several years of increasing, although additional years of data collection are necessary to confirm a change in trend. Racial and ethnic disparities remain large for asthma health care utilization and mortality.
764 citations
Additional excerpts
...0001 Smoking cessation 397 (13) 313 (13) 84 (14) NS Written action plan 51 (2) 25 (1) 26 (4) < 0....
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...09 CAD 69 (2) 18 (2) 51 (3) NS Hypertension 238 (8) 191 (7) 47 (8) NS CHF 50 (2) 37 (1) 13 (2) NS Thyroid 88 (3) 73 (3) 15 (2) NS DM 98 (3) 76 (3) 22 (4) NS Peptic ulcer 39 (1) 31 (1) 8 (1) NS GERD 160 (5) 121 (5) 39 (6) NS Arthritis 170 (5) 134 (5) 36 (6) NS Depression 406 (13) 325 (13) 81 (13) NS Cancer 58 (2) 46 (2) 12 (2) NS Other* 168 (5) 126 (5) 42 (7) 0....
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TL;DR: Findings from this study indicate that future asthma research and intervention efforts directed at hospitalizations and high-cost patients could help to decrease health care resource use and provide cost savings.
Abstract: This cost of illness analysis examines national cost and resource utilization by persons with asthma using a single, comprehensive data source, the 1987 National Medical Expenditure Survey. Direct medical expenditures included payments for ambulatory care visits, hospital outpatient services, hospital inpatient stays, emergency department visits, physician and facility payments, and prescribed medicines. Indirect medical costs included costs resulting from missed work or school and days with restricted activity at work. Point estimates and 95% confidence intervals (CI) were calculated and inflated to 1994 dollars. The total estimated cost was $5.8 billion (95% CI, $3.6 to $8 billion). The estimated direct expenditures were $5.1 billion (95% CI, $3.3 to $7.0 billion), and indirect expenditures were valued at $673 million (95% CI, $271 to $1,076 million). Hospitalization accounted for more than half of all expenditures. More than 80% of resources were used by 20% of the population (defined as 'high-cost patients'). The estimated annual per patient cost for those high-cost patients was $2,584, in contrast with $140 for the rest of the sample. Findings from this study indicate that future asthma research and intervention efforts directed at hospitalizations and high-cost patients could help to decrease health care resource use and provide cost savings.
588 citations
"Management of asthma among communit..." refers background in this paper
...02 Long-acting b2 253 (8) 175 (7) 78 (13) < 0....
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...0001 Smoking cessation 397 (13) 313 (13) 84 (14) NS Written action plan 51 (2) 25 (1) 26 (4) < 0....
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...09 CAD 69 (2) 18 (2) 51 (3) NS Hypertension 238 (8) 191 (7) 47 (8) NS CHF 50 (2) 37 (1) 13 (2) NS Thyroid 88 (3) 73 (3) 15 (2) NS DM 98 (3) 76 (3) 22 (4) NS Peptic ulcer 39 (1) 31 (1) 8 (1) NS GERD 160 (5) 121 (5) 39 (6) NS Arthritis 170 (5) 134 (5) 36 (6) NS Depression 406 (13) 325 (13) 81 (13) NS Cancer 58 (2) 46 (2) 12 (2) NS Other* 168 (5) 126 (5) 42 (7) 0....
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...Alarmingly, this represents a twofold rise in expenditures from 1987 until 1994 (12, 13)....
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TL;DR: Although the US costs of asthma increased during the 1985-1994 time period, estimated costs per person with asthma demonstrated a modest decline, which may represent a combination of reductions in hospital lengths of stay and increasing prevalence of persons with low consumption of asthma-related health care resources.
Abstract: Background: During the past decade, there have been notable changes in asthma prevalence, morbidity, and mortality. In this same time period, there have also been important national efforts to increase asthma awareness and improve asthma care. Objective: The purpose of this study was to examine the changes in US cost of illness for asthma during the 10-year period from 1985-1994. Methods: The study was a two-period (1985 and 1994), cross-sectional, cost-of-illness analysis. Cost estimates were based on US population and health care survey data available from the National Center for Health Statistics. Results: The total US costs of asthma for 1994 were $10.7 billion. On the basis of 1985 estimates adjusted to 1994 dollars, total asthma costs increased by 54.1% and direct medical expenditures increased by 20.4% during the 10-year period. In 1985, hospital inpatient care represented the largest component cost of direct medical expenditures (44.6%). Hospital inpatient costs decreased to 29.5% of direct medical expenditures in 1994, primarily because of shorter lengths of stay, as opposed to a decrease in the total number of admissions. In 1994, medications represented the largest component cost of direct medical expenditures (40.1%, up from 30.0% in 1985). The largest component increase in indirect costs was due to loss of work. On the basis of adjusted dollars, estimated costs per affected person with asthma declined by 3.4% (decrease of 15.5% for children and an increase of 2.9% for persons 18 years and older) during this time period. Conclusion: Although the US costs of asthma increased during the 1985-1994 time period, estimated costs per person with asthma demonstrated a modest decline. These findings may represent a combination of reductions in hospital lengths of stay and increasing prevalence of persons with low consumption of asthma-related health care resources. In examining the component costs, it is unclear whether these changes can be attributed to the many local, regional, and national efforts aimed at controlling untoward asthma outcomes during the 1985-1994 time period. (J Allergy Clin Immunol 2000;106:493-9.)
376 citations
"Management of asthma among communit..." refers background in this paper
...In the United States, the total indirect and direct costs related to asthma are over $10 billion (12)....
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...Alarmingly, this represents a twofold rise in expenditures from 1987 until 1994 (12, 13)....
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01 Jan 2017
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
327 citations
TL;DR: The results showed that asthma specialists provided more thorough care than did primary care physicians in treating patients with asthma and some of the variation in rates of emergency department visits and hospitalizations among some subpopulations can be explained by the underuse of preventive medication.
Abstract: Background To improve asthma disease management, the National Asthma Education Program (NAEP) Expert Panel published Guidelines for the Diagnosis and Management of Asthma in 1991. Objectives To compare the current status of asthma disease management among patients in a large health maintenance organization with the NAEP guidelines and to identify the factors that may be associated with medical care (eg, emergency department visits and hospital admissions) and adherence to the guidelines. Methods Analyses of 1996 survey data from 5580 members with asthma (age range, 14 to 65 years) covered by a major health maintenance organization in California (Health Net). Results In general, adherence to NAEP guidelines was poor. Seventy-two percent of respondents with severe asthma reported having a steroid inhaler, and of those, only 54% used it daily. Only 26% of respondents reported having a peak flowmeter, and of those, only 16% used it daily. Age (older), duration of asthma (longer), increasing current severity of disease, and treatment by an asthma specialist correlated with daily use of inhaled steroids. Ethnicity (African American and Hispanic) correlated negatively with inhaled steroid use but positively with emergency department visits and hospital admissions for asthma. Increasing age and treatment by an asthma specialist were also identified as common factors significantly related to the daily use of a peak flowmeter and, interestingly, to overuse of β 2 -agonist metered-dose inhalers. Conclusions Although the NAEP guidelines were published 7 years ago, compliance with the guidelines was low. It was especially poor for use of preventive medication and routine peak-flow measurement. Furthermore, the results showed that asthma specialists provided more thorough care than did primary care physicians in treating patients with asthma. Combining the results of the regression analyses revealed that some of the variation in rates of emergency department visits and hospitalizations among some subpopulations can be explained by the underuse of preventive medication. This study serves the goal of documenting the quality of care and services currently provided to patients with asthma through a large health maintenance organization and provides baseline information that can be used to design and assess effective population-based asthma disease management intervention programs.
320 citations
Additional excerpts
...0001 Education Environmental factors 677 (22) 464 (19) 213 (35) < 0....
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...0001 No tests documented* 1048 (34) 934 (38) 114 (19) < 0....
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...0001 Patients with 1– 3 visits to PCP since 1996 1086 (35) 972 (40) 114 (19) < 0....
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