Health Care Delivery and Quality
How and by whom care is delivered influences anti-inflammatory use in asthma: Results of a national population survey,☆☆

https://doi.org/10.1067/mai.2003.1625Get rights and content

Abstract

Background: Studies examining the influence of provider behavior and patterns of care delivery on the use of anti-inflammatory asthma therapy have been limited to selected populations or have been unable to assess the appropriateness of therapy for individuals. We have previously reported the influence of sociodemographic variables and asthma severity on reported use of asthma medications in the United States. Objective: We sought to examine the influence of patterns of care delivery and clinician behavioral factors on the use of anti-inflammatory medication by patients with asthma. Methods: We performed a cross-sectional national random digit dial household telephone survey in 1998 of adult patients and parents of children with current asthma. Respondents were classified as having current asthma if they had a physician's diagnosis of asthma and were either taking medication for asthma or had asthma symptoms during the past year. Results: One or more persons met the study criteria for current asthma in 3273 (7.8%) households in which a screening questionnaire was completed. Of the 2509 persons (721 children <16 years of age) with current asthma interviewed, 507 (20.1%) reported current use of anti-inflammatory medication. In a multiple logistic regression model controlling for asthma symptoms, reported anti-inflammatory use was significantly associated with patients reporting their physician having an excellent ability to explain asthma management (odds ratio [OR], 1.47; 95% CI, 1.09-1.98), scheduling regular visits to a physician for asthma (OR, 1.30; 95% CI, 1.02-1.64), having a written asthma action plan (OR, 1.63; 95% CI, 1.29-2.06), and being of white, non-Hispanic ethnicity (OR, 1.53; 95% CI, 1.19-1.98), along with markers of greater asthma morbidity, missing 6 or more days from work or school in the past year (OR, 1.29; 95% CI, 1.01-1.65), and hospitalization for asthma in the past year (OR, 1.74; 95% CI, 1.19-2.53). Anti-inflammatory use was less likely to be reported with younger age (OR, 0.82; 95% CI, 0.73-0.94), lower long-term asthma symptom burden (OR, 0.82; 95% CI, 0.71-0.94), use of 4 or fewer reliever inhaler canisters in the past year (OR, 0.50; 95% CI, 0.43-0.58), and smoking (OR, 0.50; 95% CI, 0.37-0.68). Conclusion: How asthma care is delivered influences the use of anti-inflammatory medication. Strategies to increase regular evaluation by a physician interested in asthma, particularly for minority patients, and to increase a physician's ability to communicate asthma management to patients might improve use of anti-inflammatory therapy among patients with asthma. (J Allergy Clin Immunol 2003;112:445-50.)

Section snippets

Methods

The data for this study come from a national sample of adult patients and parents of children with current asthma. The methods for this study have been described in detail previously.14, 15 Eligible subjects were identified by means of telephone screening of a national random digit-dialing sample of 42,022 households with telephones from May to June 1998. Persons were classified as having current asthma if they had ever been given a diagnosis of asthma by a physician and if they either took

Results

Details of the demographic profile of the study subjects are given in Table I.

. Demographic characteristics of the sampled population (n = 2509)

Variable and categoryN (unweighted)% (weighted)
Age
<6 y2028.1
6-15 y51920.7
16-34 y72829.3
≥35 y105841.8
Female sex155461.7
Race
White, non-Hispanic180770.2
Black, non-Hispanic32312.7
Other, non-Hispanic1737.3
Hispanic1778.7
Marital status
Partner151060.3
Single, previously married45918.1
Single, never married52821.2
Education
Less than high school37514.9
High school838

Discussion

Our results from a representative national sample of persons with asthma indicates that how asthma care is organized and by whom it is delivered are important factors influencing appropriate use of anti-inflammatory medication. Our results suggest areas where opportunities exist to improve use of anti-inflammatory therapy.

How care is delivered and by whom influences anti-inflammatory medication use. Scheduling regular visits with a physician for asthma is independently associated with increases

Acknowledgements

We acknowledge the assistance of Patricia Vanderwolf and John Boyle of Schulman, Ronca & Bucuvalas with statistical analysis for this study.

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    Supported by GlaxoSmithKline. Dr Adams is a recipient of the Thoracic Society of Australia and New Zealand/Allen and Hanbury's Respiratory Research Fellowship. Dr Fuhlbrigge is supported by a Mentored Clinical Scientist Development Award (1 KO8 HL03919-01) from the National Heart, Lung, and Blood Institute.

    ☆☆

    Reprint requests: Anne L. Fuhlbrigge, MD, MS, Channing Laboratory, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA 02115.

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