Prescriptive adherence to GINA guidelines and asthma control: An Italian cross sectional study in general practice

Simoni, Marzia; Angino, Anna; Baldacci, Sandra; Bresciani, M; Cerrai, Sonia; Pede, Francesco Di; Maio, Sara; Martini, Franca; Piegaia, B; Sarno, Giuseppe; Silvi, Patrizia; Viegi, Giovanni; Mangione, Maurizio; Pala, Anna Paola; Bacci, Elena; Carrozzi, Laura; Dente, Federico L.; Paggiaro, Pierluigi; Pistelli, Francesco; Bancalari, L; Foschino, Maria Pia; Pelucchi, Andrea; Moscato, Gianna; Pierimarchi, Pasquale; Brunetto, Barbara; Iacovacci, Patrizia; Pini, Carlo; Tinghino, Raffaella; Forastiére, Francesco; Perucci, Carlo A.; Porta, Daniela; Ancona, Laura; Protasi, Sara; Lazazzera, Barbara; Ziroli, Valentina; D'Armini, Eleonora; Campanile, Sabella Festa; Ferri, Maura; Lorusso, Paola; Pistelli, Riccardo; Salotti, Rita; Santagati, Marco; Agea, Elisabetta; Casciari, C; Murgia, Nicola; Spinozzi, Fabrizio; Bonifazi, Floriano; Antonicelli, Leonardo; Braschi, Maria Chiara; Conti, Valeria; Filippelli, Amelia; Corbi, Grazia Maria; Russomanno, Giusy; Braido, Fulvio; Canonica, Walter; Balbi, Francesco; Cerveri, Isa; Corsico, Angelo Guido; Grosso, Amelia

doi:10.1016/j.rmed.2018.11.001

Cited by 32 publications

(28 citation statements)

References 24 publications

(27 reference statements)

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“…Further, in all treatment steps, subjects with uncontrolled asthma reported more asthma exacerbations, healthcare utilization, and worse physical health than those with controlled asthma. From a healthcare perspective, nonadherence to asthma guidelines is common and may cause an uncontrolled disease (21)(22)(23). Guidelines recommend the use of validated questionnaires to identify the level of asthma control (1,11), nevertheless only a minority of physicians use these questionnaires on a regular basis (21,24).…”

Section: Discussionmentioning

confidence: 99%

Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health – a report from the OLIN adult asthma cohort

et al. 2020

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Objective: To study asthma exacerbations, healthcare utilization and health status among subjects with asthma with different treatment regimens and levels of asthma control. Methods: In 2012-2014, n ¼ 1425 adults from a population-based asthma cohort within the OLIN studies (Obstructive Lung disease in Northern Sweden) were invited to a follow-up including spirometry and a structured interview, n ¼ 1006 participated. Asthma Control Test (ACT) was used to detect uncontrolled asthma, and physical and mental dimensions of health were measured with SF-8. Pharmacological treatment use was classified by Global Initiative for Asthma treatment steps. Out of n ¼ 830 with current asthma, n ¼ 714 answered ACT (57% women, 32-92 years) and were included in the study. Results: Uncontrolled asthma increased per treatment step (no treatment 9.9%, treatment step 1-3 24.1%, and treatment steps 4-5 39.9%, p < 0.001). A higher proportion of subjects with uncontrolled asthma reported exacerbations, healthcare utilization, and worse health status than those with controlled asthma. The proportion of subjects reporting exacerbations, healthcare visits, emergency room visits and regular follow-up visits increased per treatment step. Worse health was associated with uncontrolled asthma, but not with the level of treatment. A higher proportion of women than men reported exacerbations, any healthcare visits, and lower health. Regular follow-up visits to a physician were uncommon (women 21.2% vs. men 14.6%, p ¼ 0.022). Conclusions: Uncontrolled asthma is common in all treatment steps, and is associated with worse health status. However, health status did not differ by treatment steps. Identifying subjects with uncontrolled asthma regardless of treatment regimens should be a priority, thus follow-up visits are important.

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Section: Discussionmentioning

confidence: 99%

Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health – a report from the OLIN adult asthma cohort

et al. 2020

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“…One study aimed to evaluate adherence to GINA guidelines and its relationship with disease control in real life. According to GINA guideline asthma classification, the results indicated overtreatment of intermittent and mild persistent asthma, as well as a general poor adherence to GINA treatment recommendations, despite its confirmed role in achieving a good asthma control 15 . In the US, nationally representative data showed that agreement with and adherence to asthma guidelines was higher for specialists than for primary care clinicians, but was low in both groups for several key recommendations 16 .…”

Section: Guidelinesmentioning

confidence: 99%

Improving primary care management of asthma: do we know what really works?

Fletcher

Tsiligianni

Kocks

et al. 2020

npj Prim. Care Respir. Med.

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Asthma imposes a substantial burden on individuals and societies. Patients with asthma need high-quality primary care management; however, evidence suggests the quality of this care can be highly variable. Here we identify and report factors contributing to high-quality management. Twelve primary care global asthma experts, representing nine countries, identified key factors. A literature review (past 10 years) was performed to validate or refute the expert viewpoint. Key driving factors identified were: policy, clinical guidelines, rewards for performance, practice organisation and workforce. Further analysis established the relevant factor components. Review evidence supported the validity of each driver; however, impact on patient outcomes was uncertain. Single interventions (e.g. healthcare practitioner education) showed little effect; interventions driven by national policy (e.g. incentive schemes and teamworking) were more effective. The panel’s opinion, supported by literature review, concluded that multiple primary care interventions offer greater benefit than any single intervention in asthma management.

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“…Individuals' with uncontrolled asthma have increased risk of morbidity and mortality, diminished quality of life, and elevated symptom burden, and ways to improve clinical care and asthma outcomes are needed (3). Fundamental to this objective is promoting multi-level adherence to evidence-based guidelines (4). It is commonly acknowledged that patients ignore symptoms, take medications inconsistently, and have poor self-management (5,6).…”

Section: Introductionmentioning

confidence: 99%

Going mobile with primary care: smartphone-telemedicine for asthma management in young urban adults (TEAMS)

et al. 2020

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Background: The majority of adults with persistent asthma have chronically uncontrolled disease and interventions to improve outcomes are needed. We evaluated the efficacy, feasibility, and acceptability of a multi-component smartphone-telemedicine program (TEAMS) to deliver asthma care remotely, support provider adherence to asthma management guidelines, and improve patient outcomes. Methods: TEAMS utilized: (1) remote symptom monitoring, (2) nurse-led smartphone-telemedicine with self-management training for patients, and (3) Electronic medical recordbased clinical decision support software. Adults aged 18-44 (N ¼ 33) and primary care providers (N ¼ 4) were recruited from a safety-net practice in Upstate New York. Asthma control, quality of life, and FEV 1 were measured at 0, 3 and 6 months. Acceptability was assessed via survey and end-of-study interviews. Paired t-test and mixed effects modeling were used to evaluate the effect of the intervention on asthma outcomes. Results: At baseline, 80% of participants had uncontrolled asthma. By 6-months, 80% classified as well-controlled. Improvements in control and quality of life were large (d ¼ 1.955, d ¼ 1.579). FEV %pred increased 4.2% (d ¼ 1.687) with the greatest gain in males, smokers, and lower educational status. Provider adherence to national guidelines increased from 43.3% to 86.7% (CI ¼ 22.11-64.55) and patient adherence to medication increased from 45.58% to 85.29% (CI ¼ 14.79-64.62). Acceptability was 95.7%; In follow up interviews, 29/30 patients and all providers indicated TEAMS worked better than usual care, supported effective selfmanagement, and reduced symptoms over time, which led to greater self-efficacy and motivation to manage asthma. Discussion: Based on these findings, we conclude that smartphone telemedicine could substantially improve clinical asthma management, adherence to guidelines, and patient outcomes.

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Prescriptive adherence to GINA guidelines and asthma control: An Italian cross sectional study in general practice

Abstract: Background: Although general practitioners (GPs) are frequently the first healthcare professionals whom asthma patients refer to for their symptoms, few studies have explored the extent of adherence to guidelines for asthma management based on data provided directly by GPs.

Cited by 32 publications

References 24 publications

Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health – a report from the OLIN adult asthma cohort

Uncontrolled asthma occurs in all GINA treatment steps and is associated with worse physical health – a report from the OLIN adult asthma cohort

Improving primary care management of asthma: do we know what really works?

Going mobile with primary care: smartphone-telemedicine for asthma management in young urban adults (TEAMS)

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