Asthma in Canada: missing the treatment targets

Chapman, K. R.

doi:10.1503/cmaj.080120

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…Our cohort was recruited from low acuity settings and we demonstrated asthma control levels that aligned with published surveys. This suggests our cohort was a valid representation of primary care and mitigates the risk that regression to the mean bias enriched our results [ 8 , 10 , 11 ]. There was strong internal consistency in our outcomes over time; early improvements were sustained for almost 2 years and across all health outcome measures.…”

Section: Lessons Learnedmentioning

confidence: 99%

Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care

Licskai

Sands

Ong

et al. 2012

International Journal for Quality in Health Care

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Quality problemInternational guidelines establish evidence-based standards for asthma care; however, recommendations are often not implemented and many patients do not meet control targets.Initial assessmentRegional pilot data demonstrated a knowledge-to-practice gap.Choice of solutionsWe engineered health system change in a multi-step approach described by the Canadian Institutes of Health Research knowledge translation framework.ImplementationKnowledge translation occurred at multiple levels: patient, practice and local health system. A regional administrative infrastructure and inter-disciplinary care teams were developed. The key project deliverable was a guideline-based interdisciplinary asthma management program. Six community organizations, 33 primary care physicians and 519 patients participated. The program operating cost was $290/patient.EvaluationSix guideline-based care elements were implemented, including spirometry measurement, asthma controller therapy, a written self-management action plan and general asthma education, including the inhaler device technique, role of medications and environmental control strategies in 93, 95, 86, 100, 97 and 87% of patients, respectively. Of the total patients 66% were adults, 61% were female, the mean age was 35.7 (SD = ±24.2) years. At baseline 42% had two or more symptoms beyond acceptable limits vs. 17% (P< 0.001) post-intervention; 71% reported urgent/emergent healthcare visits at baseline (2.94 visits/year) vs. 45% (1.45 visits/year) (P< 0.001); 39% reported absenteeism (5.0 days/year) vs. 19% (3.0 days/year) (P< 0.001). The mean follow-up interval was 22 (SD = ±7) months.Lessons learnedA knowledge-translation framework can guide multi-level organizational change, facilitate asthma guideline implementation, and improve health outcomes in community primary care practices. Program costs are similar to those of diabetes programs. Program savings offset costs in a ratio of 2.1:1

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Section: Lessons Learnedmentioning

confidence: 99%

Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care

Licskai

Sands

Ong

et al. 2012

International Journal for Quality in Health Care

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“…5 Inadequate control of asthma, as defined by previous Canadian Asthma Consensus Guidelines, 6 is present in 26% to 45% of children with asthma, 7,8 which suggests that previous guidelines have still not been fully incorporated into Canadian clinical practice. 9,10 Since publication of the 2003 version of the Canadian Pediatric Asthma Consensus Guidelines, 11 important new information has emerged from randomized controlled trials, particularly with regard to treatment with inhaled corticosteroids and use of add-on controller therapies. Further information has become available about the classification of asthma in preschool-aged children through large studies and during the planning of a large randomized trial.…”

Section: The Casesmentioning

confidence: 99%

Achieving control of asthma in preschoolers

Kovesi¹,

Schuh²,

Spier³

et al. 2009

Canadian Medical Association Journal

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“…However, despite the availability of effective treatment, studies in recent years have shown a remarkably high ratio of poorly controlled asthma. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Although asthma is due to airway inflammation some patients do not respond to anti-inflammatory therapy. [27][28][29][30][31][32][33][34][35] Different causes of this treatment failure have been discussed and different terms have been suggested for the phenomenon: severe asthma, steroidresistant asthma, and problematic and refractory asthma.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of asthma – new theories

Löwhagen

2015

Journal of Asthma

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Recent studies have indicated that "classic" asthma may sometimes be confused with asthma-like disorders such as airway sensory hyperreactivity, small airways disease, dysfunctional breathing, non-obstructive dyspnea, hyperventilation and vocal cord dysfunction. This confusion may be one explanation for the high proportion of misdiagnosis and treatment failure. The current diagnosis, focusing on bronchial obstruction, may be too "narrow". As there may be common mechanisms a broadening to include also non-obstructive disorders, forming an asthma syndrome, is suggested. Such broadening requires additional diagnostic steps, such as qualitative studies with analysis of reported symptoms, non-effort demanding methods for determining lung function, capsaicin test for revealing airway sensory hyperreactivity, careful evaluation of the therapeutic as well as diagnostic effect of corticosteroids and testing of suggested theories.

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Asthma in Canada: missing the treatment targets

Abstract: There are limits to what even careful analyses of databases can tell us about the residual morbidity of asthma in Canada and how we can improve asthma management. Although Klomp and colleagues reported that only 37% of patients

Cited by 5 publications

References 11 publications

Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care

Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care

Achieving control of asthma in preschoolers

Diagnosis of asthma – new theories

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