Community Asthma Program improves appropriate prescribing in moderate to severe asthma

Abstract

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 (kappa = 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 chi2 = 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.