Undiagnosed Chronic Obstructive Pulmonary Disease Contributes to the Burden of Health Care Use. Data from the CanCOLD Study.

RATIONALE: Chronic obstructive pulmonary disease (COPD) remains undiagnosed in many individuals with persistent airflow limitation. These individuals may be susceptible to exacerbation-like respiratory events that consume health care resources. OBJECTIVES: To compare exacerbation-like respiratory events, event prevalence, and differences in the odds of using medication and/or health services between subjects with diagnosed and undiagnosed COPD. METHODS: Subjects sampled from the general population participating in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study, with at least 12 months of exacerbation-event follow-up who were classified as having physician-diagnosed or undiagnosed COPD were assessed. Exacerbation-like respiratory events were captured using a questionnaire administered every 3 months. MEASUREMENTS AND MAIN RESULTS: A total of 355 subjects were undiagnosed and 150 were diagnosed with COPD. Undiagnosed subjects were less symptomatic and functionally impaired, had been prescribed fewer respiratory medications, and had better health status. The incidence of reported exacerbation-like events was higher in diagnosed subjects and increased in both groups with the severity of airflow obstruction. Although subjects with diagnosed COPD were more often prescribed medication for exacerbation events, health service use for exacerbation events was similar in both groups. CONCLUSIONS: Most subjects with COPD in Canada remain undiagnosed. These subjects are less symptomatic and impaired, which may partly explain lack of diagnosis. Although patients with undiagnosed COPD experience fewer exacerbations than those with diagnosed COPD, they use a similar amount of health services for exacerbation events; thus, the overall health system burden of exacerbations in those with undiagnosed COPD is considerable.

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.

Can universal access to health care eliminate health inequities between children of poor and nonpoor families?: A case study of childhood asthma in Alberta.

STUDY OBJECTIVE: Children from poor families are much more likely to have emergency visits for asthma than those from nonpoor families, which may be related to financial access barriers to good preventive care for the poor. We sought to determine whether in a health-care system that provides free access to outpatient and hospital services, the disparities in the rates of emergency visits for asthma would be less apparent across the income gradient. DESIGN: Longitudinal, population-based study. SETTING: Alberta, Canada. PARTICIPANTS: All children born in Alberta, Canada between 1985 and 1988 (n = 90,845) were classified into three mutually exclusive groups based on the reported annual income of their parents from the previous year: very poor, poor, and nonpoor groups. MEASUREMENTS AND RESULTS: We compared the relative risk (RR) of emergency visits for childhood asthma among children of very poor, poor, and nonpoor families using a Cox proportional hazard model during a 10-year follow-up. We found that the very poor children were 23% more likely to have had an emergency visit for asthma than those from nonpoor families (RR, 1.23; 95% confidence interval [CI], 1.14 to 1.33), adjusted for a variety of factors. The poor group, however, had a similar risk of asthma emergency visits as the nonpoor group (RR, 0.97; 95% CI, 0.91 to 1.04). The average number of office visits for asthma was similar between the very poor and nonpoor groups. CONCLUSIONS: In a setting of universal access to health care, children of poor and nonpoor families had similar rates of asthma emergency visits; the very poor children, however, continued to experience an excess risk. These findings suggest that a universal health-care system can reduce, but not fully eliminate, the disparities in emergency utilization of asthma across income categories.