Medical literature and government (Federal & State) reports that Hispanics suffer greater morbidity and mortality from asthma than the general population. This study compares the efficacy between a goal oriented management with the current NAEPP guidelines in this population since there is not a Spanish version of them and are inaccesible to patients.
A retrospective observational study based on expenditures paid by Blue Shield Puerto Rico for the years 2003-04 for services provided for the treatment of asthma. The services compared were office visits, ED admissions, ICU admissions, medications,readmissions and all diagnostic & therapeutic procedures per patient/year.Population was divided in two groups:A- 24,320 patients treated by 108 pneumologists with presumed knowledge of NAEPP guidelines in private offices.B- 1,094 patients treated by a team of a physician, therapist, nurse, and assistant. The management followed faithfully the Asthma Patient Bill of Rights (APBOR)Spanish version. Each person received a copy of the document.Patients were of low middle and middle class and Spanish was their principal language. On February Blue Shield provided the expenses paid for the previous year in U.S. dollars.
Data showed huge differences between groups. The goal oriented had lowest expenses when compared to the standard therapy group saving $3 millions. No deaths in the goal oriented group and many in the standard group. Deaths occurred more at home or in route to hospital than in the ICU admissions. Readmissions were 20% within 15 days after discharge in the standard therapy group.There were no readmissions in the goal oriented group.
Results were positive beyond expectations. No mortality and less morbidity in the goal oriented treatment group with great savings in resources. Current NAEPP guidelines are ignored by physicians creating inadequate prescriptions patterns and no patient education and support.
A goal oriented management based on Spanish language guidelines (APBOR) generate commitment in patients, relatives, physicians with an unexpected positive outcome in Hispanics asthmatics.
Ramon Figueroa-Lebron, None.