Frequency of Asthma Education in Primary Care for the Years 2007-2010 Marquise Lee, MSCR 1, Kevin Cross, PharmD, MSCR 1, Wan Yu Yang, MSCR 1, Michael Jiroutek,

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Frequency of Asthma Education in Primary Care for the Years Marquise Lee, MSCR 1, Kevin Cross, PharmD, MSCR 1, Wan Yu Yang, MSCR 1, Michael Jiroutek, DrPH 1, Beth Sutton, PhD 1 1 Campbell University College of Pharmacy & Health Sciences, Buies Creek, North Carolina Overall rate of asthma education remained low Overall asthma education rate not significantly changed between the years as compared to Trend towards less asthma education in Age, gender, smoking status, ethnicity, physician specialty, and payment type were found to be significant in the univariate analyses From a multivariable logistic regression model, controlling for covariates, only physician specialty and ethnicity were found to be independent predictors of asthma education Statistically significant association between asthma education and Physician specialty – pediatricians more likely than physicians in internal medicine to provide asthma education Ethnicity – Hispanics/Latinos were more likely than non-Hispanics/Latinos to receive asthma education Potential Limitations of this Study Table 2. Primary Analysis Asthma education can be a critical component in the treatment of patients diagnosed with asthma. It often covers numerous aspects including recognition of triggers, proper medication/inhaler use, and written asthma action plans. Studies have previously demonstrated numerous benefits of asthma education, including reduction of emergency room visits 1 and hospitalizations. 2 The prevalence of asthma in the United States differs significantly with regards to age, gender, race, and geographical region. 3 A better understanding of the factors affecting its provision can lead to better health outcomes for patients and a reduced burden on the healthcare system. 3 Table 3. Secondary Analysis Background Objectives Conclusions Limitations Results Table 4. Multivariable Logistic Regression Study Design Retrospective, cross-sectional, observational study Inclusion Criteria NAMCS participation during years Visit to primary care physician (internal medicine, pediatrics, and family practice/general practice) Diagnosis of asthma using ICD-9 coding (493.x) Extrinsic asthma Intrinsic asthma Chronic obstructive asthma Other forms of asthma Asthma, unspecified Exclusion Criteria There were no exclusion criteria for this study Primary and secondary endpoint Receipt of asthma education Primary Analysis Chi-square test Test of association of patients who received asthma education in years compared to years Secondary Analyses Chi-square tests Association of asthma education and each of the secondary variables Multivariable logistic regression identifying predictors of asthma education, controlling for covariates Statistical Analyses P-values, odds ratios (OR) and corresponding 95% confidence intervals (CI) were computed Visits were weighted to enable extrapolation to national estimates Based on the weighting and clustering variables provided in the NAMCS dataset Statistical significance, unless otherwise noted, was defined at the 0.05 level Primary Objective To determine if there was a difference in the proportion of patients diagnosed with asthma who received asthma education and participated in the National Ambulatory Medical Care Survey (NAMCS) in the years compared to the years Secondary Objective To determine if there was an association between receipt of asthma education and each of the following variables: age, gender, race/ethnicity, smoking status, insurance type, controller medication, visit to primary care physician, physician specialty, allied health profession involvement, visit type, geographic region, urban or rural clinic, and year for subjects who were diagnosed with asthma and participated in NAMCS during the years of Methods References Boyd L, Lasserson TJ, McKean MC, Gibson PG, Ducharme FM, Haby M. Interventions for educating children who are at risk of asthma-related emergency department attendance. The Cochrane Collaboration [online]. 20 Jan Available at: Accessed 10 July Coffman JM, Cabana MD, Halpin HA, Yelin EH. Effects of asthma education on children’s use of acute care services: a meta-analysis. Pediatrics. Mar 2008;121(3): Centers for Disease Control and Prevention. Vital Signs: Asthma Prevalence, Disease Characteristics, and Self-Management Education – United States, May 2011;60(17) Available at: Accessed 12 July randomized 20 conventional VariableYes N (%)No N (%)OR (95% CI)** Age ≤18 > (41.8) 178 (21.5) 419 (58.2) 649 (78.5) Reference 0.3 ( )* Gender Male Female 261 (36.1) 230 (26.5) 462 (63.9) 637 (73.5) Reference 0.6 ( )* Race White Non-white 279 (33.8) 110 (33.1) 547 (66.2) 222 (66.9) Reference 0.8 ( ) Ethnicity Non-Hispanic or Latino Hispanic or Latino 279 (31.6) 130 (43.2) 603 (68.4) 171 (56.8) Reference 3.3 ( )* Smoking status Not current Current 385 (35.6) 27 (18.0) 698 (64.4) 123 (82.0) Reference 0.5 ( )* Primary Care Provider Yes No 404 (30.6) 63 (37.1) 917(69.4) 107 (62.9) Reference 1.7 ( ) Population density Urban Rural 456 (31.3) 35 (26.3) 1001 (68.7) 98 (73.9) Reference 0.8 ( ) Controller prescribed Yes No 44 (33.9) 447 (30.6) 86(66.1) 1013 (69.4) Reference 0.8 ( ) Allied health involvement No Yes 357 (33.0) 134 (26.4) 726 (67.0) 373 (73.6) Reference 0.6 ( ) Payment type Private Insurance Medicare Medicaid/Self pay/No charge 225 (31.5) 27 (17.0) 204 (33.7) 489 (68.5) 131 (82.9) 401 (66.3) Reference 0.5( )* 1.7 ( )* Physician specialty Internal medicine Pediatrics Family (general) practice 49 (18.9) 280 (43.6) 162 (23.6) 211 (81.1) 362 (56.4) 526 (76.4) Reference 4.3 ( )* 1.5 ( ) Visit type Chronic problem Acute or new problem Preventative care 227 (32.2) 167 (28.5) 87 (31.9) 477 (67.8) 420 (71.5) 186 (68.1) Overall test not significant. No OR’s computed Region Northeast Midwest South West 103 (30.4) 101 (29.1) 188 (36.7) 99 (25.3) 236 (69.2) 246 (70.9) 324 (63.3) 293 (74.7) Overall test not significant. No OR’s computed. VariableOR (95% CI) Physician specialty Internal medicine Family (general) practice Pediatrics Reference 1.7 ( ) 2.9 ( )* Ethnicity Not Hispanic or Latino Hispanic or Latino Reference 2.5 ( )* Years Yes N (%) No N (%) OR (95% CI) (32.1) 239 (29.7) 532 (67.9) 567 (70.3) Reference 0.9 ( ) Receipt of asthma education from as compared to CharacteristicN (%) (Total =1590) Gender Female Male Age - years <18 >18 Race White Non-white Ethnicity Non-Hispanic/Latino Hispanic/Latino Year (54.5) 723 (45.5) 720 (46.5) 827 (53.5) 826 (71.3) 332 (28.7) 882 (74.6) 301 (25.4) 784 (49.3) 806 (50.7) Table 1. Demographics Snapshot in time Quality of education Nature of education not recorded Asthma education views May differ across providers Unable to determine if diagnoses are new or pre-existing * Significant at P-value <0.05 ** Weighted and clustered Age, gender, smoking status, ethnicity, physician specialty, and payment type were found to be significant in the univariate analyses, but not in the multivariable analysis Disclosures The authors of this study received no external funding and have no affiliations to declare.