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A primary care-based asthma program improves recognition and treatment of persistent asthma in inner-city children
1a Department of Pediatrics, The Children's Hospital at Montefiore , Albert Einstein College of Medicine , Bronx , NY , USA.
Insights
A primary care asthma program improved the detection and treatment of persistent asthma in inner-city children. The program, using Expert Panel Report 3 (EPR-3) guidelines, identified more cases of moderate to severe persistent asthma and increased controller medication use.
Area of Science:
- Pediatric Pulmonology
- Primary Care Medicine
- Asthma Management
Background:
- Asthma is a significant chronic respiratory disease in children, particularly in inner-city populations.
- Underdiagnosis and undertreatment of asthma are common in routine primary care settings.
- Effective asthma management requires accurate classification of severity and appropriate treatment escalation.
Purpose of the Study:
- To evaluate a primary care-based asthma program utilizing Expert Panel Report 3 (EPR-3) guidelines.
- To determine if the program improves the detection of persistent asthma in inner-city children.
- To assess the impact of the program on asthma treatment "step of care" compared to routine care.
Main Methods:
- Retrospective chart review of 97 children referred to an asthma program (2011-2013).
- Comparison of asthma severity documented during routine care versus assessment using standardized questions and spirometry in the asthma program.
- Analysis of medication plan "step of care" changes pre- and post-program visit.
Main Results:
- 79 children (ages 5-19) met study criteria.
- The program identified significantly more children with moderate to severe persistent asthma (75.3%) compared to routine care (15.2%).
- Following the program, controller medication use increased (82.3% vs 63.3%), and 40.6% of patients had their treatment stepped up.
Conclusions:
- Primary care-based asthma programs applying EPR-3 criteria can enhance asthma severity detection.
- Formalized asthma assessment in primary care leads to improved recognition and treatment of persistent asthma in underserved children.
- Implementing structured asthma programs in primary care settings is crucial for addressing underdiagnosis and undertreatment.
Objective:
To examine whether a primary care-based asthma program that applies the Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-2007 criteria to classify asthma severity increases detection of persistent asthma in inner-city children and affects "step of care" compared to routine care.
Methods:
A retrospective chart review was conducted of 97 consecutive children referred to the asthma program from 2011-2013. Asthma severity documented during routine health care maintenance visits was compared to the asthma severity assessed during the asthma program visit using five standardized questions and spirometry. Medication plan "step of care" was compared pre- and post- the asthma program visit.
Results:
79 children, ages 5-19 years old (mean = 9.6), had spirometry tracings meeting American Thoracic Society criteria and were included in this study. 53% were male. The majority of children were Latino (45.6%) or African American (35.4%). At the asthma program visit, more children were identified with moderate or severe persistent asthma based upon clinical questions (47.9%), spirometry (56.9%) or combined criteria (75.3%) than had been identified during routine care (15.2%); all p < .05. After the asthma program visit, more children were prescribed controller medications (82.3% vs 63.3%; p < .05) and 40.6% had their medication plan stepped up.
Conclusions:
In this population of inner-city children, asthma severity was under-recognized and undertreated during routine care. A primary care based asthma program, which formalized applying EPR-3 criteria, increased detection of persistent asthma and led to "step-ups" in treatment plans.
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