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Large care gaps in primary care management of asthma: a longitudinal practice audit.

Submitted by karopka on Tue, 2019/11/26 - 19:29
TitleLarge care gaps in primary care management of asthma: a longitudinal practice audit.
Publication TypeJournal Article
Year of Publication2019
AuthorsPrice, C, Agarwal, G, Chan, D, Goel, S, Kaplan, AG, Boulet, L-P, Mamdani, MM, Straus, SE, Lebovic, G, Gupta, S
JournalBMJ Open
Volume9
Issue1
Paginatione022506
Date Published2019 01 29
ISSN2044-6055
Abstract

OBJECTIVES: Care gaps in asthma may be highly prevalent but are poorly characterised. We sought to prospectively measure adherence to key evidence-based adult asthma practices in primary care, and predictors of these behaviours.DESIGN: One-year prospective cohort study employing an electronic chart audit.SETTING: Three family health teams (two academic, one community-based) in Ontario, Canada.PARTICIPANTS: 884 patients (72.1% female; 46.0±17.5 years old) (4199 total visits; 4.8±4.8 visits/patient) assigned to 23 physicians (65% female; practising for 10.0±8.6 years).MAIN OUTCOME MEASURES: The primary outcome was the proportion of visits during which practitioners assessed asthma control according to symptom-based criteria. Secondary outcomes included the proportion of: patients who had asthma control assessed at least once; visits during which a controller medication was initiated or escalated; and patients who received a written asthma action plan. Behavioural predictors were established a priori and tested in a multivariable model.RESULTS: Primary outcome: Providers assessed asthma control in 4.9% of visits and 15.4% of patients. Factors influencing assessment included clinic site (p=0.019) and presenting symptom, with providers assessing control more often during visits for asthma symptoms (35.0%) or any respiratory symptoms (18.8%) relative to other visits (1.6%) (p<0.01).SECONDARY OUTCOMES: Providers escalated controller therapy in 3.3% of visits and 15.4% of patients. Factors influencing escalation included clinic site, presenting symptom and prior objective asthma diagnosis. Escalation occurred more frequently during visits for asthma symptoms (21.0%) or any respiratory symptoms (11.9%) relative to other visits (1.5%) (p<0.01) and in patients without a prior objective asthma diagnosis (3.5%) relative to those with (1.3%) (p=0.025). No asthma action plans were delivered.CONCLUSIONS: Major gaps in evidence-based asthma practice exist in primary care. Targeted knowledge translation interventions are required to address these gaps, and can be tailored by leveraging the identified behavioural predictors.TRIAL REGISTRATION NUMBER: NCT01070095; Pre-results.

DOI10.1136/bmjopen-2018-022506
Alternate JournalBMJ Open
PubMed ID30696669
PubMed Central IDPMC6352804
Grant List236225 / / CIHR / Canada
322013 / / CIHR / Canada
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