Variation in primary care asthma management effects outcomes

Published Online: January 20, 2016

Prior studies have shown that children with asthma have fewer symptoms and emergency department visits if they have regular preventive care visits with an asthma specialist who can identify and address parental concerns, provide education and support, monitor asthma control and medication use and adjust the treatment plan as needed.  However, most children with asthma are managed by their primary care pediatrician and little is know about the content and impact of preventive asthma care visits in this setting.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Garbutt and colleagues describe variation in primary care management of asthma amongst 22 practices that serve children from diverse socio-demographic groups. Using data from parent interviews and chart reviews they assessed preventive and acute care visits over 12 months as well as asthma outcomes for 948 children who were 3 to 12 years old. They also investigated if children attending practices who provided more preventive and acute care had improved asthma outcomes.

This study identified wide variation in asthma care in the primary care setting. The proportion of children in the practice with at least one preventive care visit in the 12-month study period ranged from 8% to 90% (median 71%). Details of care such as providing education and assessing asthma control were rarely documented and it appeared that many children were not receiving guideline recommended asthma care. Overall, practices provided about twice as many visits for acute asthma care than for preventive care. Controlling for the child’s age, race, Medicaid insurance, single parent status, season and report of at least one specialist visit for asthma care in the past 12 months, they found that children attending practices providing more asthma care, both preventive and acute, had fewer emergency department (ED) visits.

The authors concluded that study findings support guideline recommendations for regular preventive care visits with primary care providers and highlight the need for effective strategies to increase implementation of these recommendations. They suggest that allergists consider taking a leadership role to foster a learning community for primary care providers in their medical neighborhood.  They could provide mentorship, education and support to encourage primary care providers to have more frequent follow-up visits to provide some of the feature of specialist care suggested to favorably impact asthma outcomes such as a systemized approach to identify and address problems with medication use, self-management  and management of atopic triggers and allergic rhinitis.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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