Category: Fellows Posters
Purpose: National Asthma Education and Prevention Program (NAEPP) and Global Initiative for Asthma (GINA) recommend routine assessment and modification of asthma treatments using a step-wise approach. African American (AA) and Hispanic and Latino (H/L) individuals bear a disproportionately larger share of asthma morbidity and mortality compared to Caucasian individuals and despite this known disparity, they are less likely to receive guideline concordant care. The purpose of this study was to assess the level of guideline concordant care being provided to AA or H/L individuals in primary care settings and if it results in improved asthma outcomes.
Methods: This was a cohort study looking at 20 randomly selected patients at the time of screening for a randomized controlled trial and their visits at a primary care or pulmonary specialty clinics at a single institution. Those enrolled were adults age 18 or older prescribed ICS for asthma who self-identify as AA or H/L. Guideline concordant care was defined as receiving any of the following: assessment of asthma (defined by Asthma Control Test or other physician assessment), provision of self-management education, and/or step-wise medication adjustments. These interventions were assessed individually and as a composite. The co-primary outcomes were frequency of asthma assessment and frequency of receipt of guideline concordant care at those visits. Descriptive statistics were used for analysis.
Results: There were 85 total encounters for asthma care across all participants at our institution during the year prior to enrollment. There were 80 primary care or asthma specialist visits. Average number of clinic visits per person was 3.6 +/- 2.7 (SD). Of the total visits, 22 (27.5%) visits did not assess asthma, 31 (38.8%) visits assessed asthma as controlled, and 27 (33.8%) visits assessed asthma as uncontrolled. Of those assessed as controlled, 12 (38.7%) assessed an ACT (mean score 21.5 +/- 2.5 SD) and one visit involved a reduction in controller medication dose. Of those assessed as uncontrolled, 19 (70.4%) assessed an ACT (mean score 12 +/- 3.5 SD). At these visits where patients were deemed to have uncontrolled asthma, 13 (48.1%) had no controller change, 8 (29.6%) started or resumed use of a controller, 6 (22.2%) changed therapy, and 6 (22.2%) received short course of oral prednisone.
Conclusion: In our patient analysis, approximately one fourth of AA and H/L patients do not have asthma assessed when attending primary care or asthma specialist visits. When assessed as uncontrolled, only 52% of encounters resulted in a medication change response to achieve guideline concordant care. These results highlight a need to further educate healthcare professionals on guideline concordant care among highly impacted adults with asthma. The clinical significance of these results must be determined in larger, long-term clinical trials.