Asthma Disease Management Programs (ADMP) have been demonstrated to improve asthma symptom control and decrease the need for hospitalizations, ER visits and days out of work/school. However availability of ADMP in primary care settings has been limited due to costs and available practitioner time.This is a report of a collaborative model of Family Physician (FP) directed ADMP employing an asthma educator acting as the agent for the FP.
25 patients (average age 47 yrs (range 18-60 yrs), F/M ratio 4:1) with moderate persistent asthma (NAEPP guidelines) were enrolled in an ADMP including the development of an asthma written care plan (WCP) codeveloped with the patients FP, and including audit of the plan by an asthma pulmonary specialist (See Diagram). Baseline information of asthma control and healthcare resource utilization (hospitalizations, ER visits etc) were obtained by questionnaire. Patient education was delivered both by the asthma educator and the FP during the course of routine office visits. Followup data was collected by phone contact.
Patients received one in-person contact from the AE and 3 phone contacts for further education reinforcement during the 6 month followup period. Patients experienced an average of 1.2 hospitalizations and 2.8 ER visits in the 12 months prior to the ADMP intervention. At 6 months post intervention, none of the 25 study patients required either hospitalization nor ER care. Urgent office visits also decreased from an average of 6/patient to 3 visits. All patient reported significant improvement in asthma control post ADMP. Using regional average charges for ER and hospital visits for asthma the average cost savings is estimated at $12,000 per patient.
We conclude that a structured ADMP can be delivered in a primary care setting employing an AE, with asthma specialist audit, resulting in improvements in healthcare resource utilization and patient reported asthma control.
Primary Care delivered ADMP can be effectively accomplished with the aid of an AE to create a information interchange between patient, primary care provider and specialist.
W.F. Bria, None.