MANAGING ASTHMA

Managing Asthma In A Pre Clinical Audit



Managing Asthma In A Pre Clinical Audit

Background

Asthma is one of the most common chronic diseases and its prevalence has increased markedly during the past few decades in Western Europe. This places a large burden on patients and health care. It is estimated, for example, that about 15 million disability-adjusted life years are lost per year due to asthma, and that asthma accounts for about 1 of each 250 deaths worldwide. In children, asthma accounts for many lost school days which may result in deprivation of educational achievement and social interaction.

Studies from the UK found immigrants to be disproportionately affected by asthma. Immigrant children were found to have higher asthma related mortality rates and hospitalizations rates than their peers. For other Western countries, information on ethnic inequalities in asthma related mortality and morbidity is scant.

Methodology

Design

We performed an audit of asthma care provided two years preceding an asthma exacerbation. The six primary care centres in Amsterdam Southeast and the paediatric department of the Academic Medical Centre-University of Amsterdam all participated in the audit. On the basis of review criteria data on processes of care were collected by extracting data from medical records and by means of structured interviews. Subsequently, two panels of experts assessed (possible) shortcomings in asthma care and its relation to the occurrence of the asthma exacerbation. These panels were both multidisciplinary and each consisted of a general practitioner (GP), a paediatrician, a paediatric lung specialist, and a physician assistant or a nurse-practitioner.

Patients

All children aged 6-16 years who, during the period December 2002 till June 2003, consulted one of the six primary healthcare centres in Amsterdam Southeast or the paediatric department of the Academic Medical Centre-University of Amsterdam with an asthma exacerbation, were selected. These children all needed to have a physician diagnosis of asthma. A child was considered to have an asthma exacerbation when it consulted a physician outside scheduled visits because of shortness of breath.( Masoli, 2004 472)

Data collection

Based upon the formulated review criteria a questionnaire was constructed in such a way it was possible to collect data on the formulated review criteria. In addition, data was gathered on patient characteristics and medical history regarding provoking factors and severity of complaints. This so the experts could judge the asthma care provided two years before asthma exacerbation taking asthma severity, asthmatic recurrences and provoking factors into account. With this questionnaire a research ...