TY - JOUR
T1 - Community asthma program improves appropriate prescribing in moderate to severe asthma
AU - Moonie, Sheniz A.
AU - Strunk, Robert C.
AU - Crocker, Sue
AU - Curtis, Vanessa
AU - Schechtman, Kenneth
AU - Castro, Mario
N1 - Funding Information:
Supported by Grant/Cooperative Agreement Number U59/CCU723263 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. *Corresponding author: Mario Castro, M.D., M.P.H., Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Campus Box 8052, 660 S. Euclid Ave., St. Louis, MO 63110-1093, USA; E-mail: [email protected]
PY - 2005
Y1 - 2005
N2 - Asthma guidelines, established by the National Asthma Education and Prevention Panel (NAEPP), seek to guide physicians in the appropriate assessment and treatment of asthma. Poor physician adherence to these guidelines has been documented because of a variety of reported barriers. We sought to test the efficacy of the Community Asthma Program (CAP), which was designed to help primary care physicians (PCP) assess asthma severity and to prescribe medications according to NAEPP guidelines. A prospective, observational study was conducted in 723 patients with asthma (aged < 1-85 years) in two primary care clinics. PCPs had access to patient responses to asthma symptom questions at each visit. The correlations between patient self-reported and PCP-classified asthma severity, treatment prescribed, and missed days from work or school were determined. The effect of the intervention on guideline adherence was assessed by asthma severity level and time. An overall moderate measure of agreement was found between patient self-reported and PCP-classified asthma severity (K = 0.48; p < 0.001) although this agreement decreased with increasing severity of asthma. Patient self-reported (r = 0.14; p < 0.001) and PCP-classified (r = 0.17; p < 0.001) asthma severity was weakly correlated with missed days from work or school. Those with severe persistent asthma were 89% less likely to be appropriately treated than the mild intermittent group (OR = 0.11; 95% CI-0.1-0.2). This relationship was not influenced by the different clinics or providers nor by the age of the patient. Over time, the CAP-trained PCPs were more likely to appropriately prescribe asthma medications for those with moderate to severe asthma (Mantel-Haenszel χ2 = 5.11; p = 0.02). Despite appropriate assessment of asthma severity, physicians are undertreating patients with severe asthma, the group with the highest health care use. Use of the CAP over time aided PCPs in appropriately medicating patients with moderate to severe asthma in accordance with guidelines.
AB - Asthma guidelines, established by the National Asthma Education and Prevention Panel (NAEPP), seek to guide physicians in the appropriate assessment and treatment of asthma. Poor physician adherence to these guidelines has been documented because of a variety of reported barriers. We sought to test the efficacy of the Community Asthma Program (CAP), which was designed to help primary care physicians (PCP) assess asthma severity and to prescribe medications according to NAEPP guidelines. A prospective, observational study was conducted in 723 patients with asthma (aged < 1-85 years) in two primary care clinics. PCPs had access to patient responses to asthma symptom questions at each visit. The correlations between patient self-reported and PCP-classified asthma severity, treatment prescribed, and missed days from work or school were determined. The effect of the intervention on guideline adherence was assessed by asthma severity level and time. An overall moderate measure of agreement was found between patient self-reported and PCP-classified asthma severity (K = 0.48; p < 0.001) although this agreement decreased with increasing severity of asthma. Patient self-reported (r = 0.14; p < 0.001) and PCP-classified (r = 0.17; p < 0.001) asthma severity was weakly correlated with missed days from work or school. Those with severe persistent asthma were 89% less likely to be appropriately treated than the mild intermittent group (OR = 0.11; 95% CI-0.1-0.2). This relationship was not influenced by the different clinics or providers nor by the age of the patient. Over time, the CAP-trained PCPs were more likely to appropriately prescribe asthma medications for those with moderate to severe asthma (Mantel-Haenszel χ2 = 5.11; p = 0.02). Despite appropriate assessment of asthma severity, physicians are undertreating patients with severe asthma, the group with the highest health care use. Use of the CAP over time aided PCPs in appropriately medicating patients with moderate to severe asthma in accordance with guidelines.
KW - Adherence
KW - Asthma
KW - Barriers
KW - National asthma education and prevention guidelines
UR - http://www.scopus.com/inward/record.url?scp=22044440486&partnerID=8YFLogxK
U2 - 10.1081/JAS-200057900
DO - 10.1081/JAS-200057900
M3 - Article
C2 - 16032937
AN - SCOPUS:22044440486
SN - 0277-0903
VL - 42
SP - 281
EP - 289
JO - Journal of Asthma
JF - Journal of Asthma
IS - 4
ER -