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Community Asthma Program improves appropriate prescribing in moderate to severe asthma
Sheniz A Moonie1, Robert C Strunk, Sue Crocker
1Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Campus Box 8052, 660 S. Euclid Ave., St. Louis, MO 63110-1093, USA.
Summary
Physician adherence to asthma guidelines improved with the Community Asthma Program (CAP), especially for moderate to severe asthma cases. The CAP helps primary care physicians (PCPs) better manage asthma according to National Asthma Education and Prevention Panel (NAEPP) guidelines.
Area of Science:
- Pulmonary Medicine
- Clinical Practice Guidelines
- Healthcare Quality Improvement
Background:
- Physician adherence to National Asthma Education and Prevention Panel (NAEPP) guidelines is crucial for effective asthma management.
- Barriers to guideline adherence by primary care physicians (PCPs) have been reported, leading to suboptimal patient care.
- The Community Asthma Program (CAP) was developed to assist PCPs in assessing asthma severity and prescribing appropriate medications.
Purpose of the Study:
- To evaluate the efficacy of the Community Asthma Program (CAP) in improving PCP adherence to NAEPP asthma guidelines.
- To assess the correlation between patient-reported asthma severity, PCP-classified severity, and impact on daily life (missed work/school days).
- To determine if the CAP intervention influences appropriate asthma medication prescription based on severity.
Main Methods:
- A prospective, observational study involving 723 asthma patients across two primary care clinics.
- PCPs utilized patient-reported symptom data to assess asthma severity at each visit.
- Statistical analyses, including kappa statistics, correlation coefficients, and Mantel-Haenszel chi-squared tests, were used to assess agreement and treatment efficacy over time.
Main Results:
- Moderate agreement was observed between patient-reported and PCP-classified asthma severity (kappa = 0.48), decreasing with increased severity.
- Weak correlations were found between asthma severity (both patient-reported and PCP-classified) and missed work/school days.
- Patients with severe persistent asthma were significantly less likely to be appropriately treated (OR = 0.11).
- The CAP intervention demonstrated a positive effect over time, increasing appropriate medication prescription for moderate to severe asthma cases (p = 0.02).
Conclusions:
- Despite adequate asthma severity assessment, undertreatment of severe asthma persists, impacting high healthcare users.
- The Community Asthma Program (CAP) effectively improved PCP medication prescribing for moderate to severe asthma, aligning with NAEPP guidelines.
- Interventions like CAP are vital for enhancing guideline adherence and optimizing asthma care in primary care settings.