The use of a work-related asthma screening questionnaire in a primary care asthma program: an intervention trial.

OBJECTIVES: The work-related asthma screening questionnaire (long-version) (WRASQ(L)) is a 14-item tool designed to increase the recognition of work-related asthma (WRA) in primary care. The purpose of this study was to assess whether the WRASQ(L) provided additional information about a patient's likelihood of WRA, beyond what was collected in standard care, and to assess the use of the WRASQ(L) in the primary care setting. METHODS: This was an intervention study involving two Ontario primary care sites. Standard care for asthma patients in these sites involved completing the Asthma Care Map (ACM), a template for asthma management that includes seven WRA screening items. Participation in this study involved completing an electronic WRASQ(L) at each visit for participants and prompted care providers to record details related to WRA investigations. Ethics approval was obtained from an Institutional Review Board. RESULTS: The study sample (N = 37) was predominantly female (73.0%), with a mean age of 46.3 years (SD, 10.9). The use of WRASQ(L) identified additional work-related symptoms in 38% and exposures in 60% of participants over and above those identified by the ACM. Two participants were newly suspected of WRA during the study period. CONCLUSIONS: The WRASQ(L) provided added information about possible WRA over standard care. The use of the questionnaire's results by care providers was limited due to barriers encountered in incorporating the use of electronic version of the WRASQ(L) into clinical practice. Once validated and implemented in practice, the WRASQ(L) has the potential to increase the recognition of WRA.

The development and test re-test reliability of a work-related asthma screening questionnaire.

OBJECTIVE: Work-related asthma (WRA) is under-recognized and delays in recognition contribute to long-term morbidity. The objective of the project was to develop a WRA screening questionnaire for use by primary care providers in the assessment of individuals with asthma, and to evaluate the respondent burden, test re-test reliability and face validity of the questionnaire. METHODS: A literature search was undertaken and an expert advisory committee was convened. A questionnaire was drafted and assessed for feasibility of use and content validity. The study enrolled patients with asthma attending outpatient clinics and an asthma education center. Participants were asked to respond to the questionnaire on two occasions, and comment on the content (face validity) and ease of completion (respondent burden). Ethics approval was obtained from an institutional review board. RESULTS: A 14-item self-administered screening questionnaire was created. Thirty-nine participants were recruited, and 26 participants completed a second administration of the questionnaire. The items on the relation of asthma symptoms to work demonstrated substantial agreement between testings. The workplace exposures items were found to have good reproducibility. The majority of participants denied that items were repetitive, not useful or difficult to understand. CONCLUSIONS: We have developed a WRA screening questionnaire designed to aid primary care providers in the recognition of possible WRA. The tool exhibited content and face validity, good test re-test reliability and low respondent burden. Participant feedback is being considered in revisions of the questionnaire.

Development and implementation of an electronic asthma record for primary care: integrating guidelines into practice.

RATIONALE: Evidence-based practice may be enhanced by integrating knowledge translation tools into electronic medical records (EMRs). We examined the feasibility of incorporating an evidence-based asthma care map (ACM) into Primary Care (PC) EMRs, and reporting on performance indicators. METHODS: Clinicians and information technology experts selected 69 clinical and administrative variables from the ACM template. Four Ontario PC sites using EMRs were recruited to the study. Certified Asthma Educators used the electronic ACM for patient assessment and management. De-identified data from consecutive asthma patients were automatically transmitted to a secure central server for analysis. RESULTS: Of the four sites recruited, two sites using "stand-alone" EMR systems were able to incorporate the selected ACM variables into an electronic format and participate in the pilot. Data were received on 161 visits by 130 patients aged 36.5 ± 26.9 (mean ± SD) (range 2-93) years. Ninety-four percent (65/69) of the selected ACM variables could be analyzed. Reporting capabilities included: individual patient, individual site and aggregate reports. Reports illustrated the ability to measure performance (e.g. number of patients in control, proportion of asthma diagnoses confirmed by an objective measure of lung function), benchmark and use EMR data for disease surveillance (e.g. number of smokers and the individuals with suspected work-related asthma). CONCLUSIONS: Integration of this evidence-based ACM into different EMRs was successful and permitted patient outcomes monitoring. Standardized data definitions and terminology are essential in order for EMR data to be used for performance measurement, benchmarking and disease surveillance.

Comparison of asthma control criteria: importance of spirometry.

AIMS: To compare the measurements of asthma control using Canadian Thoracic Society (CTS) Asthma Management Consensus Summary and Global Initiative for Asthma (GINA) guidelines composite indices with and without spirometry. METHODS: Asthma control parameters were extracted from electronic medical records (EMRs) of patients ≥6 years old at two primary care sites. Asthma control ratings calculated according to CTS and GINA criteria were compared. RESULTS: Data were available from 113 visits by 93 patients, aged 6-85 years (38.7 ± 24.8; mean ± SD). The proportion of visits at which individuals' asthma was completely controlled was 22.1% for CTS symptoms only and 9.7% for CTS with spirometry (p < .01); and 17.7% versus 14.1% for GINA symptoms only versus symptoms with spirometry (p = .125). CONCLUSIONS: Asthma control ratings using GINA and CTS criteria are discordant in more than half of the patients deemed "in control" by at least one scale. Differences in the spirometry criterion threshold are primarily responsible for this discordance. Failure to include spirometry as part of the control index consistently overestimates asthma control and may underestimate future risk of exacerbations.

Rugby injury in Kingston, Canada: a ten-year study.

Rugby is a high-contact sport with an elevated risk for injury. While many studies have examined the epidemiology of rugby injury, there are no surveillance-based injury studies from North America. The objective of this study was to profile the scope and nature of injuries experienced during the sport of rugby. We analyzed emergency department injury surveillance data over a decade (1993-2003) from the Kingston sites of the Canadian Hospital Injury Reporting and Prevention Program. Rugby injuries were examined by mechanism, nature and anatomical site of injury, with stratification according to sex and age. A total of 1,527 injuries was observed (mean of 153 per year). Results show the tackling phase of play accounted for the highest number of injuries (506/1,527; 33.1 percent). The most common natures of injury were sprains and strains (426/1,527; 27.9 percent), while the leading anatomical location of injury was the face (294/1,527; 19.3 percent). Target patterns of injury were identified as priorities for prevention, based on injury frequency and severity.

Stages of development and injury patterns in the early years: a population-based analysis.

BACKGROUND: In Canada, there are many formal public health programs under development that aim to prevent injuries in the early years (e.g. 0-6). There are paradoxically no population-based studies that have examined patterns of injury by developmental stage among these young children. This represents a gap in the Canadian biomedical literature. The current population-based analysis explores external causes and consequences of injuries experienced by young children who present to the emergency department for assessment and treatment. This provides objective evidence about prevention priorities to be considered in anticipatory counseling and public health planning. METHODS: Four complete years of data (1999-2002; n = 5876 cases) were reviewed from the Kingston sites of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), an ongoing injury surveillance initiative. Epidemiological analyses were used to characterize injury patterns within and across age groups (0-6 years) that corresponded to normative developmental stages. RESULTS: The average annual rate of emergency department-attended childhood injury was 107 per 1000 (95% CI 91-123), with boys experiencing higher annual rates of injury than girls (122 vs. 91 per 1000; p < 0.05). External causes of injury changed substantially by developmental stage. This lead to the identification of four prevention priorities surrounding 1) the optimization of supervision; 2) limiting access to hazards; 3) protection from heights; and 4) anticipation of risks. CONCLUSION: This population-based injury surveillance analysis provides a strong evidence-base to inform and enhance anticipatory counseling and other public health efforts aimed at the prevention of childhood injury during the early years.