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Rege S, Kavati A, Ortiz B, Mosnaim G, Cabana MD, Murphy K, Aparasu RR. Documentation of asthma control and severity in pediatrics: analysis of national office-based visits. J Asthma 2019; 57:205-216. [PMID: 30657001 DOI: 10.1080/02770903.2018.1554069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To evaluate the extent of documentation of asthma control and severity and associated characteristics among pediatric asthma patients in office-based settings. Methods: This cross-sectional study utilized data from the 2012-2015 National Ambulatory Medical Care Survey (NAMCS). Patients aged 6-17 years with a diagnosis of asthma were included. Weighted descriptive analysis examined the extent of documentation and uncontrolled asthma; while logistic regression evaluated associated characteristics. Results: Overall, there were 2.47 million (95% confidence interval, 95% CI: 2.04-2.90) average annual visits with asthma as a primary diagnosis. Asthma control and severity was documented in only 36.1% and 33.8% of the visits, respectively. An established patient (odds ratio, OR = 3.81), Hispanic ethnicity (OR = 2.10), chronic sinusitis (OR = 5.59), and visits in the Northeast (OR = 2.12) and Midwest (OR = 2.25) regions had higher odds of documented asthma control status, whereas undocumented asthma severity (OR = 0.02), and visits in spring (OR = 0.34), had lower odds. Osteopathic doctors (OR = 0.18), visits in the Northeast region (OR = 0.23), chronic sinusitis (OR = 0.08), and undocumented asthma control status (OR = 0.03) had lower odds of documented asthma severity, whereas visits in spring (OR = 3.88) and autumn (OR = 3.32) had higher odds. Moderate/severe persistent asthma (OR = 15.35) had higher odds of uncontrolled asthma (as compared to intermittent asthma), while visits in the summer (OR = 0.14) had lower odds. Conclusion: The findings of this study suggest a critical need to increase the documentation of asthma severity and control to improve quality of asthma care in children.
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Affiliation(s)
- Sanika Rege
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA
| | - Abhishek Kavati
- US Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Benjamin Ortiz
- US Clinical Development and Medical Affairs, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Michael D Cabana
- Department of Pediatrics, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Kevin Murphy
- Boys Town National Research Hospital, Boys Town, NE, USA
| | - Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA
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2
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Rojanasarot S, Heins Nesvold J, Karaca-Mandic P, St Peter WL, Wolfson J, Schommer JC, Carlson AM. Enhancing guideline-based asthma care processes through a multi-state, multi-center quality improvement program. J Asthma 2018; 56:440-450. [PMID: 29641271 DOI: 10.1080/02770903.2018.1463378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This study investigated the effectiveness of Enhancing Care for Patients with Asthma (ECPA)-a collaborative quality improvement program implemented in 65 community health centers that serve asthma patients in four states-on clinic-based asthma performance measures consistent with national guidelines. METHODS This study utilized a pretest-posttest quasi-experimental design. Six clinic-based performance measures of each center were collected from a retrospective chart review at time points: before the ECPA implementation; at the end of the 12-month long ECPA program; and 6 months after program completion. The effectiveness of the ECPA was assessed using generalized linear mixed models with a Poisson distribution and log link by evaluating the change in each measure from baseline to program completion, from baseline to 6-month post-program completion and from program completion to 6-month post-program completion. RESULTS The ECPA implementation was positively associated with improvement in all measures from baseline to program completion: documentation of asthma severity (rate ratio (RR) 1.314; 95% confidence interval (CI) 1.206, 1.432); Asthma Control Test (RR 3.625; 95% CI 3.185, 4.124); pulmonary function testing (RR 1.771; 95% CI 1.527, 2.054), asthma education (RR 2.246; 95% CI 2.018, 2.501), asthma action plan (RR 2.335; 95% CI 2.070, 2.634) and controller medication (RR 1.961; 95% CI 1.504,2.556). Improvement was sustained for all six measures at the 6-month post-program completion time point. CONCLUSION This study demonstrated the favorable effect of the ECPA program on evidence-based asthma quality measures. This program could be considered a model worth replication on a broader scale.
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Affiliation(s)
- Sirikan Rojanasarot
- a Department of Pharmaceutical Care & Health Systems, College of Pharmacy , University of Minnesota , Minneapolis , Minnesota , USA
| | | | - Pinar Karaca-Mandic
- c Department of Finance , Carlson School of Management University of Minnesota , Minneapolis , Minnesota , USA
| | - Wendy L St Peter
- a Department of Pharmaceutical Care & Health Systems, College of Pharmacy , University of Minnesota , Minneapolis , Minnesota , USA
| | - Julian Wolfson
- d Division of Biostatistics, School of Public Health , University of Minnesota , Minneapolis , Minnesota , USA
| | - Jon C Schommer
- a Department of Pharmaceutical Care & Health Systems, College of Pharmacy , University of Minnesota , Minneapolis , Minnesota , USA
| | - Angeline M Carlson
- a Department of Pharmaceutical Care & Health Systems, College of Pharmacy , University of Minnesota , Minneapolis , Minnesota , USA.,e Data Intelligence Consultants, LLC , Eden Prairie , Minnesota , USA
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3
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Lee MG, Cross KJ, Yang WY, Sutton BS, Jiroutek MR. Frequency of asthma education in primary care in the years 2007-2010. J Asthma 2015; 53:220-6. [PMID: 26313596 DOI: 10.3109/02770903.2015.1087024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Recent research suggests that health disparities persist among asthmatic patients and receipt of asthma education, though recent guidelines have highlighted the importance of receiving asthma education. The purpose of this study was to identify trends in the receipt of asthma education as well as to identify disparities in asthma education using the most recently available data in National Ambulatory Medical Care Survey, 2007-2010. METHODS Weighted chi-square tests were conducted to identify associations between asthma education and variables of interest. A weighted multivariate logistic regression model was subsequently constructed to jointly assess the association of factors of interest on receipt of asthma education. Submission to the Campbell University Institutional Review Board resulted in expedited approval. RESULTS The percentage of patients who receive asthma education remains quite low. After adjusting for all variables of interest: no statistically significant difference in receipt of asthma education between year groups (2007-2008, 2009-2010) was found (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.52-1.34); patients seen by pediatricians (vs. internal medicine physicians) and Hispanic or Latino patients (vs. non-Hispanic or Latino patients) were more likely to receive asthma education (OR 2.72, 95% CI 1.11-6.66 and OR 2.33, 95% CI 1.18-4.60, respectively); and patients not prescribed a controller medication were less likely to receive asthma education than those who were (OR 0.56, 95% CI 0.37-0.82). CONCLUSIONS Combined with previously published results, it appears the provision of asthma education continues to be low, despite proven benefits. Additionally, some patient and physician characteristics may be associated with the delivery of asthma education.
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Affiliation(s)
- Marquise G Lee
- a Department of Clinical Research , Campbell University College of Pharmacy & Health Sciences , Buies Creek , NC , USA
| | - Kevin J Cross
- a Department of Clinical Research , Campbell University College of Pharmacy & Health Sciences , Buies Creek , NC , USA
| | - Wan Yu Yang
- a Department of Clinical Research , Campbell University College of Pharmacy & Health Sciences , Buies Creek , NC , USA
| | - Beth S Sutton
- a Department of Clinical Research , Campbell University College of Pharmacy & Health Sciences , Buies Creek , NC , USA
| | - Michael R Jiroutek
- a Department of Clinical Research , Campbell University College of Pharmacy & Health Sciences , Buies Creek , NC , USA
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4
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Hart MK, Millard MW. Approaches to chronic disease management for asthma and chronic obstructive pulmonary disease: strategies through the continuum of care. Proc AMIA Symp 2010; 23:223-9. [PMID: 20671816 PMCID: PMC2900972 DOI: 10.1080/08998280.2010.11928623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Investigator-initiated research in both asthma and chronic obstructive pulmonary disease conducted at the Baylor Martha Foster Lung Care Center has sought to improve management throughout the continuum of respiratory care using a multidisciplinary approach. Respiratory care therapists employed in the primary care setting were shown to improve the quality of asthma care: rescue inhaler use decreased by 75% and respiratory symptom score decreased by 49% in patients who were seen by this midlevel specialty provider. In addition to similar results in a geriatric population, patients' diagnosis was changed in 48% of cases and treatment was changed in 76% of cases after the intervention. For pulmonary rehabilitation, an activity of daily living assessment form was created, and rehabilitation-whether traditional or water-based-was shown to improve patients' ability to perform activities of daily living and improve quality of life scores. The Rules of Two((R)), developed by Baylor University Medical Center at Dallas to simplify understanding of good asthma control, continues to be taught, and patient education has also been offered through asthma summer camps for children. Finally, a multidisciplinary team worked to develop a protocol for treatment of asthma patients in the emergency department and, through this effort, was able to reduce length of stay from an average of 278 minutes to an average of 168 minutes. These efforts aim to overcome the gap between recommended care and actual practice, so that patients benefit from evidence-based medicine and continuing refinements to diagnosis and treatment.
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Affiliation(s)
- Mary K Hart
- Baylor Martha Foster Lung Care Center and Baylor University Medical Center at Dallas
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Stingone JA, Claudio L. Disparities in allergy testing and health outcomes among urban children with asthma. J Allergy Clin Immunol 2008; 122:748-753. [PMID: 19014766 DOI: 10.1016/j.jaci.2008.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 07/31/2008] [Accepted: 08/04/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous research has found that treating allergies and reducing exposure to allergens can reduce asthma morbidity. OBJECTIVE We sought to examine whether urban asthmatic children were receiving care for allergies as part of a comprehensive asthma management plan. METHODS A cross-sectional study, consisting of a parent-reported questionnaire, was conducted in 26 randomly selected New York City public elementary schools during the 2002-2003 school year. RESULTS In a sample of 5,250 children aged 5 to 12 years, 13.0% were found to have current asthma. The prevalence of allergy diagnosis was 21.0%. Less than half (47.3%) of the subjects with current asthma reported a physician's diagnosis of allergies. The frequency of a reported allergy diagnosis varied with race/ethnicity, ranging from 14.4% in Mexican American children to 67.9% in white children. Only 54.9% of asthmatic children with an allergy diagnosis reported allergy testing. Children from lower-/middle-income households and children with public forms of health insurance were the least likely to report testing (adjusted odds ratios, 0.18 and 0.46). Higher frequencies of reported allergy testing were associated with education on allergen avoidance, use of allergy medications, lower exposure to household allergens, and lower prevalence of wheezing. CONCLUSIONS Many children do not receive comprehensive asthma treatment that includes management of allergies and education on avoidance of household allergens. Lower reported allergy testing might indicate lower access to medical care among middle-income families who are ineligible for public programs but who do not have the income to access higher-quality care. Interventions aimed at improving medical care and adherence to treatment guidelines are necessary to decrease asthma morbidity.
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Affiliation(s)
- Jeanette A Stingone
- Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY
| | - Luz Claudio
- Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY.
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Weiss KB. Asthma guidelines: invited commentaries. Proc (Bayl Univ Med Cent) 2006; 13:412-3. [PMID: 16389352 PMCID: PMC1312242 DOI: 10.1080/08998280.2000.11927716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- K B Weiss
- Center for Health Services Research, Rush Primary Care Institute
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Sheffer AL. Asthma guidelines: invited commentaries. Proc (Bayl Univ Med Cent) 2000; 13:415. [PMID: 16389354 PMCID: PMC1312244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Affiliation(s)
- A L Sheffer
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine Brigham and Women's Hospital, USA
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Hallstrand TS. Asthma guidelines: invited commentaries. Proc (Bayl Univ Med Cent) 2000; 13:413-4. [PMID: 16389353 PMCID: PMC1312243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Affiliation(s)
- T S Hallstrand
- Division of Pulmonary and Critical Care, University of Washington, USA
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