Urban and rural differences in the management of asthma amongst primary care physicians in Alberta.

BACKGROUND: Inconsistencies in rural and urban health care exist; however, little has been done to evaluate the potential differences in asthma management. OBJECTIVE: To compare asthma management in rural versus urban primary care physician practices. METHODS: Forty-two of 136 consenting primary care physicians were randomly selected for chart review. The charts of 3072 patients diagnosed with asthma based on the ICD-9 Classification of Diseases were reviewed. RESULTS: Standards of asthma care were compared between rural and urban primary care physicians. 2671 patients (87%) were cared for by urban physicians and 401 patients (13%) by rural physicians. Greater proportions of male and pediatric patients were found in the rural group. Rural patients made more emergency department or hospital visits than urban patients. Rural physicians performed more pulmonary function tests and made more referrals to other healthcare specialists. Urban patients had more asthma symptoms and triggers documented and used peak flow monitoring more often. Urban physicians provided more asthma education and prescribed more oral corticosteroids and antibiotics. Overall, rates of referral, use of spirometry and use of written action plans were low globally. CONCLUSIONS: Our study indicates that the management of asthma in the rural settings is comparable to that of urban settings. Improvements in the areas of pulmonary function testing, asthma education and use of written action plans are necessary in both settings.

The costs of implementing the 1999 Canadian Asthma Consensus Guidelines recommendation of asthma education and spirometry for the family physician.

BACKGROUND: National and international asthma guidelines recommend that patients with asthma be provided with asthma education and spirometry as a component of enhanced asthma care. The cost of implementing these interventions in family physician practices is not known. OBJECTIVE: The objective of the present study was to determine the cost of providing recommended asthma care to adult patients in the family practice setting. METHODS: The present study was conducted using three scenarios of care in family practice. Small, medium and large asthmatic patient populations were used. The incremental costs of implementing enhanced asthma care based on the Canadian Asthma Consensus Guidelines, including the provision of spirometry and asthma education in both group and individual sessions, and the resources required for these interventions were calculated for each scenario. RESULTS: For a physician with 50 asthmatic patients, the cost of providing enhanced asthma care with spirometry and group education sessions was approximately 78 dollars per patient in the first year of implementation. For individual sessions, the cost increased to 100 dollars per patient for the first year. If the physician had 100 asthmatic patients, the per patient cost would decrease; however, the overall cost of the program would be 7,000 dollars. CONCLUSIONS: The costs of providing enhanced asthma care are significant. In most cases, physicians are inadequately reimbursed (or not reimbursed) for these interventions. In light of the evidence of the effectiveness of these interventions, health insurance plans should consider adding these services to fee schedules.

Alberta Strategy to Help Manage Asthma (ASTHMA): a provincial initiative to improve outcomes for individuals with asthma.

As society struggles with escalating healthcare costs, and a general increase in the prevalence as well as the morbidity of common chronic conditions such as asthma and diabetes, patient health management programs offer new opportunities to improve the process of care, create efficiencies in the healthcare system and enhance the outcomes of patients suffering from these conditions.