Obstructive Lung Diseases: Asthma Guidelines and Outcomes |

Impact of Type of Health-care Provider on Long-term Asthma Care in Children: A Model for Primary Care FREE TO VIEW

Shahid Sheikh, MD; Judy Pitts, APN; Nancy Ryan-Wenger, PhD; Don Hayes, Jr., MD; Karen McCoy, MD
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Ohio State University/Nationwide Children's Hospital, Columbus, OH

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):886A. doi:10.1016/j.chest.2016.08.986
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SESSION TITLE: Asthma Guidelines and Outcomes

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 07:30 AM - 08:30 AM

PURPOSE: Asthma prevalence is on rise worldwide and adherence with preventive guidelines is less than adequate at primary care offices. We enrolled children referred from primary care practices with the diagnosis of uncontrolled asthma in a specialty asthma clinic and managed their asthma as per NAEPP guidelines. Aim of the study was to document improvement, if any, in asthma control in children referred from primary care with uncontrolled asthma by managing their asthma as per NAEPP (EPR-3) guidelines.

METHODS: Study cohort: After local IRB approval 823 children with asthma referred to the Pediatric Asthma Center at local Children’s hospital between 2011-2014 were enrolled into the study and followed every 3-6 months. Families completed a survey (questionnaire) at every clinic visit. Children enrolled in pediatric asthma center were provided asthma care as per NAEPP guidelines. Asthma control was evaluated at each visit and if needed medications were changed. Asthma action plan was revised accordingly and reviewed with family at each visit. Asthma education for families included basic information on NAEPP guidelines, asthma action plan, asthma triggers, severity-specific diagnosis of asthma, medications and adherence. Patients were seen by either physicians or APN (Advanced Practice Nurses). The distribution of scores was measured by mean, standard deviation, median, and interquartile range depending upon the normality of the data. Differences in asthma indicators over time were measured by Wilcoxin signed ranks tests between 2 time points. Alpha level of significance was ≤ .05.

RESULTS: The sample included 823 children; ages 2 to 17 years (mean 6.9±4.4). Male: Female 477 (58%): 346 (42%). Most of the children were diagnosed with moderate persistent asthma as per NAEPP/NIH guidelines. All acute care need scores (hospital admissions, emergency department visits, urgent care visits, primary care visits, school days missed, short courses of oral steroids and number of days requiring albuterol improved significantly at 3 month follow up visit (p<0.05 for all) and improvement persisted for 4 year follow-up period. Similarly symptom scores: mean number of days/month with wheeze, night time cough or exercise related symptoms and number of prolonged colds/month significantly decreased between the baseline (initial visit) and 3 month office visit (p<0.001 for all) and improvement persisted over time. ACT scores increased significantly between the first and 3 month visits (16.9 ±5.7 and 20 ±5.2, p<0.05) and improvement persisted for four years. Improvement in these parameters was not dependent on health care provider as there was comparable improvement between those see by physician and those seen and followed by nurse practitioner.

CONCLUSIONS: Better asthma control can be achieved in children by managing their asthma as per NAEPP (EPR-3) guidelines and is not dependent on health care provider. Asthma guidelines need to be followed at primary care offices.

CLINICAL IMPLICATIONS: Asthma is a disease of primary care. Following guidelines improve asthma care. Choice of type of health care providers is not significant as long as guidelines are followed. This model can be applied to primary care offices.

DISCLOSURE: The following authors have nothing to disclose: Shahid Sheikh, Judy Pitts, Nancy Ryan-Wenger, Don Hayes, Jr., Karen McCoy

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