Quality of asthma care under different primary care models in Canada: a population-based study

Abstract

BackgroundPrevious research has shown variations in quality of care and patient outcomes under different primary care models. The objective of this study was to use previously validated, evidence-based performance indicators to measure quality of asthma care over time and to compare quality of care between different primary care models.MethodsData were obtained for years 2006 to 2010 from the Ontario Asthma Surveillance Information System, which uses health administrative databases to track individuals with asthma living in the province of Ontario, Canada. Individuals with asthma (n=1,813,922) were divided into groups based on the practice model of their primary care provider (i.e., fee-for-service, blended fee-for-service, blended capitation). Quality of asthma care was measured using six validated, evidence-based asthma care performance indicators.ResultsAll of the asthma performance indicators improved over time within each of the primary care models. Compared to the traditional fee-for-service model, the blended fee-for-service and blended capitation models had higher use of spirometry for asthma diagnosis and monitoring, higher rates of inhaled corticosteroid prescription, and lower outpatient claims. Emergency department visits were lowest in the blended fee-for-service group.ConclusionsQuality of asthma care improved over time within each of the primary care models. However, the amount by which they improved differed between the models. The newer primary care models (i.e., blended fee-for-service, blended capitation) appear to provide better quality of asthma care compared to the traditional fee-for-service model.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0232-y) contains supplementary material, which is available to authorized users.

Current status of asthma care in South Korea: nationwide the Health Insurance Review and Assessment Service database

“…The majority of patients were treated in primary health clinics, and only 5% of the patients were treated in tertiary hospitals. Although PFT and ICS are the most important diagnostic and treatment methods, respectively, only 23.47% of patients with asthma were assessed with PFT, and 25.37% of patients were treated Results of earlier studies correspond with those of the present study, which reported low PFT rates in the asthma population; however, these studies have reported a higher rate than that in the present study (11,(14)(15)(16). A population-based study in Canada revealed that the PFT rate improved from 2006 to 2010 at both the initial diagnosis (46.8% to 52.5%) and during monitoring (16.4% to 19.1%) (11).…”

“…Only 13% of Asia-Pacific patients with asthma in the 2003 Asthma Insights and Reality in Asia-Pacific (AIRIAP) study were prescribed an ICS (12). In a Canadian study, researchers reported that the ICS prescription rate increased from 2006 to 2010 (72.9% to 76.6%) (11). In addition, ICS therapy was used by 38.4% of patients with asthma in the GEDA study, and younger patients had a lower prescription rate (31.6% vs. 50.3%) (14).…”

“…Pulmonary function testing (PFT) is the mainstay for diagnosing and monitoring patients with asthma, and inhaled corticosteroids (ICS) are the most important medications (8,10). However, only half of patients with asthma undergo PFT at diagnosis and <20% of patients do so at follow-up (11). Other studies that targeted Asia-Pacific patients reported that only 13% of patients are treated with an ICS (12).…”

Planned primary health care asthma contacts during 12-year follow-up after Finnish National Asthma Programme: focus on spirometry

“…Inclusion of spirometry in the assessment guarantees more accurate monitoring of asthma control [38][39][40][41] without input from secondary care 43 . Objective lung function measurements are not comprehensively used in asthma diagnostics 44 and monitoring 2,3,45 , despite several studies [38][39][40][41] and guidelines 1 supporting their use. A Swedish study showed that one third of the patients with asthma visiting PHC during initial visits and approximately half of the patients during follow-up visits had a clinical evaluation, including spirometry or peak flow monitoring, in agreement with recommendations 2 .…”

Developments in asthma incidence and prevalence in Alberta between 1995 and 2015

“…For example, an accurate asthma diagnosis with pulmonary function testing and then proper treatment and general practitioner follow-up can lead to less ED visits, hospitalizations, time off-work, impaired lung function and mortality which could translate into cost savings in the long term. Descriptive epidemiological studies that can accurately identify the burden of chronic disease such as asthma are important for disease monitoring over time, resource allocation and measuring the effectiveness of interventions 34 .…”