PURPOSE: To determine whether a portable, electronically supported, inter-disciplinary, primary care, asthma education and treatment program can be implemented effectively across a community, achieve guideline based asthma treatment objectives, and improve health outcomes.
METHODS: We developed a primary care program, the Essex County Community Asthma Care Strategy (ECCACS), as a community model for asthma guideline implementation. Certified asthma educators, supported by standardized software, completed a comprehensive evaluation of the patients’ asthma and provided guideline-based education. A final management plan was developed collaboratively with the primary care physician at each visit.
RESULTS: Between October 2004 and November 2006, 523 asthma patients and 33 physicians in 19 sites participated. Guideline objectives were completed by educators: spirometry in 90.6% of patients; role of medication in 94.3%; inhaler device technique in 96.3%; environmental control strategies in 86.7%; and a written self-management action plan in 77.8%. Asthma control and healthcare utilization data was available on 316 patients (60%) who attended follow-up appointments (median 70 days). At baseline 212 patients (67.1%) had uncontrolled asthma based on one Canadian Consensus Guidelines (CCG) symptom parameter outside of benchmark and 133 patients (42.1%) based on two or more benchmarks. On follow-up 115 patients (36.4%) had uncontrolled asthma based on one CCG symptom benchmark a relative reduction of 54.2% (p<0.001) and 55 patients (17.4%) based on two or more benchmarks, a relative reduction of 41.4% (p<0.001). Healthcare utilization was measured as unscheduled physician visits, emergency room visits, and hospitalization for asthma. Data for healthcare utilization on follow-up was annualized. The baseline mean was 3.26 (sd=4.63) visits per year. Post-intervention patients had a mean of 1.35 visits per year (-1.92, -58.6% of baseline, p<0.001).
CONCLUSION: An interdisciplinary community based primary care asthma guideline implementation program (ECCACS) effectively implemented guidelines, improved asthma control and healthcare utilization.
CLINICAL IMPLICATIONS: Many patients with asthma are not achieving the control benchmarks established by guidelines. Programs that implement evidence-based care at the community level provide an opportunity for patients to achieve asthma control and improve healthcare utilization.
DISCLOSURE: Christopher Licskai, No Financial Disclosure Information; No Product/Research Disclosure Information