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Original Research: Asthma |

Costs and Health Outcomes Associated With Primary vs Secondary Care After an Asthma-Related HospitalizationType of Care and Asthma-related Outcomes: A Population-Based Study

Mohsen Sadatsafavi, MD, PhD; Mark FitzGerald, MD; Carlo Marra, PharmaD, PhD; Larry Lynd, PhD
Author and Funding Information

From the Institute for Heart and Lung Health (Drs Sadatsafavi and FitzGerald), Faculty of Medicine; the Centre for Clinical Epidemiology and Evaluation (Drs Sadatsafavi and FitzGerald), Vancouver Coastal Health Institute; Collaboration for Outcomes Research and Evaluation (Drs Sadatsafavi, Marra, and Lynd), Faculty of Pharmaceutical Sciences; and the Centre for Health Evaluation and Outcome Sciences (Drs Marra and Lynd), The University of British Columbia, Vancouver, BC, Canada.

Correspondence to: Mohsen Sadatsafavi, MD, PhD, Centre for Clinical Epidemiology and Evaluation, 7th Floor, 828 W 10th Ave, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada; e-mail: msafavi@mail.ubc.ca


Funding/Support: This study is part of the project “Platform for Outcomes Research and Translation in Asthma and Allergy (PORTAL)” funded by the AllerGen National Center of Excellence. Dr Lynd is a Michael Smith Foundation for Health Research (MSFHR) Scholar and Canadian Institutes of Health Research (CIHR) New Investigator. Dr Marra is funded by a Canada Research Chair in Pharmaceutical Outcomes. Dr Sadatsafavi receives salary support from the Institute for Heart and Lung.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(2):428-435. doi:10.1378/chest.12-2773
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Background:  Patients with a history of asthma-related hospitalizations are at high risk of readmission and generally consume a large amount of health-care resources. It is not clear if the secondary care provided by specialists after an episode of asthma-related hospitalization is associated with better outcomes compared with the primary care provided by general practitioners.

Methods:  Using population-based administrative health data from the province of British Columbia, Canada, we created a propensity-score-matched cohort of individuals who received primary vs secondary care in the 60 days after discharge from asthma-related hospitalization. Total direct asthma-related medical costs (primary outcome) and health service use and measures of medication adherence (secondary outcomes) were compared for the next 12 months.

Results:  Two thousand eighty-eight individuals were equally matched between the primary and secondary care groups. There was no difference in the direct asthma-related costs (difference $567; 95% CI, −$276 to $1,410) and rate of readmission (rate ratio [RR] = 1.06; 95% CI, 0.85-1.32) between the secondary and the primary care groups. Patients under secondary care had a higher rate of asthma-related outpatient service use (RR = 1.22; 95% CI, 1.11-1.35) but a lower rate of short-acting β-agonist dispensation (RR = 0.91; 95% CI, 0.85-0.98). The proportion of days covered with a controller medication was higher among the secondary care group (difference of 3.2%; 95% CI, 0.4%-6.0%).

Conclusions:  Compared with those who received only primary care, patients who received secondary care showed evidence of more appropriate treatment. Nevertheless, there were no differences in the costs or the risk of readmission. Adherence to asthma medication in both groups was poor, indicating the need for raising the quality of care provided by generalists and specialists alike.

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