Large care gaps in primary care management of asthma: a longitudinal practice audit Academic Article uri icon

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abstract

  • ObjectivesCare gaps in asthma may be highly prevalent but are poorly characterised. We sought to prospectively measure adherence to key evidence-based adult asthma practices in primary care, and predictors of these behaviours.DesignOne-year prospective cohort study employing an electronic chart audit.SettingThree family health teams (two academic, one community-based) in Ontario, Canada.Participants884 patients (72.1% female; 46.0±17.5 years old) (4199 total visits; 4.8±4.8 visits/patient) assigned to 23 physicians (65% female; practising for 10.0±8.6 years).Main outcome measuresThe primary outcome was the proportion of visits during which practitioners assessed asthma control according to symptom-based criteria. Secondary outcomes included the proportion of: patients who had asthma control assessed at least once; visits during which a controller medication was initiated or escalated; and patients who received a written asthma action plan. Behavioural predictors were established a priori and tested in a multivariable model.ResultsPrimary outcome: Providers assessed asthma control in 4.9% of visits and 15.4% of patients. Factors influencing assessment included clinic site (p=0.019) and presenting symptom, with providers assessing control more often during visits for asthma symptoms (35.0%) or any respiratory symptoms (18.8%) relative to other visits (1.6%) (p<0.01). Secondary outcomes: Providers escalated controller therapy in 3.3% of visits and 15.4% of patients. Factors influencing escalation included clinic site, presenting symptom and prior objective asthma diagnosis. Escalation occurred more frequently during visits for asthma symptoms (21.0%) or any respiratory symptoms (11.9%) relative to other visits (1.5%) (p<0.01) and in patients without a prior objective asthma diagnosis (3.5%) relative to those with (1.3%) (p=0.025). No asthma action plans were delivered.ConclusionsMajor gaps in evidence-based asthma practice exist in primary care. Targeted knowledge translation interventions are required to address these gaps, and can be tailored by leveraging the identified behavioural predictors.Trial registration numberNCT01070095; Pre-results.

authors

  • Price, Courtney
  • Agarwal, Ragini Gina
  • Chan, David
  • Goel, Sanjeev
  • Kaplan, Alan G
  • Boulet, Louis-Philippe
  • Mamdani, Muhammad M
  • Straus, Sharon E
  • Lebovic, Gerald
  • Gupta, Samir

publication date

  • January 2019