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Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized Controlled Trial.
- Source :
-
Annals of family medicine [Ann Fam Med] 2018 Mar; Vol. 16 (2), pp. 100-110. - Publication Year :
- 2018
-
Abstract
- Purpose: The purpose of this study was to assess patient and practice outcomes after introducing the Asthma APGAR (Activities, Persistent, triGGers, Asthma medications, Response to therapy) tools into primary care practices.<br />Methods: We used a pragmatic cluster-randomized controlled design in 18 US family medicine and pediatric practices to compare outcomes in patients with persistent asthma aged 5 to 45 years after introduction of the Asthma APGAR tools vs usual care. Patient outcomes included asthma control, quality of life, and emergency department (ED), urgent care, and inpatient hospital visits. The practice outcome was adherence to asthma guidelines.<br />Results: We enrolled 1,066 patients: 245 children, 174 adolescents, and 647 adults. Sixty-five percent (692 patients) completed both baseline and 12-month questionnaires, allowing analysis for patient-reported outcomes. Electronic health record data were available for 1,063 patients (99.7%) for practice outcomes. The proportion of patients reporting an asthma-related ED, urgent care, or hospital visit in the final 6 months of the study was lower in the APGAR practices vs usual care practices (10.6% vs 20.9%, P = .004). The percentage of patients with "in control" asthma increased more between baseline and 1 year in the APGAR group vs usual care group (13.5% vs 3.4%, P =.0001 vs P =.86) with a trend toward better control scores and asthma-related quality of life in the former at 1 year ( P ≤.06 and P = .06, respectively). APGAR practices improved their adherence to 3 or more guideline elements compared with usual care practices (20.7% increase vs 1.9% decrease, P = .001).<br />Conclusions: Introduction of the Asthma APGAR tools improves rates of asthma control; reduces asthma-related ED, urgent care, and hospital visits; and increases practices' adherence to asthma management guidelines.<br />Competing Interests: Conflicts of interest: Barbara P. Yawn served on asthma and COPD advisory boards for Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Teva. Young Juhn received support for asthma research from Genentech. All other authors report no conflicts of interest.<br /> (© 2018 Annals of Family Medicine, Inc.)
- Subjects :
- Adolescent
Adult
Ambulatory Care statistics & numerical data
Asthma diagnosis
Child
Child, Preschool
Cross-Over Studies
Emergency Service, Hospital statistics & numerical data
Family Practice methods
Female
Humans
Logistic Models
Male
Middle Aged
Minnesota
Office Visits statistics & numerical data
Patient Reported Outcome Measures
Primary Health Care methods
Quality of Life
Severity of Illness Index
Surveys and Questionnaires
Time Factors
Young Adult
Asthma therapy
Family Practice standards
Guideline Adherence statistics & numerical data
Primary Health Care standards
Subjects
Details
- Language :
- English
- ISSN :
- 1544-1717
- Volume :
- 16
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Annals of family medicine
- Publication Type :
- Academic Journal
- Accession number :
- 29531100
- Full Text :
- https://doi.org/10.1370/afm.2179