Use of lung function tests in paediatric asthma care A nationwide registry study Grete Moth, MHSc, Ph.D Danish Paediatric Asthma Centre Aarhus University.

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Presentation transcript:

Use of lung function tests in paediatric asthma care A nationwide registry study Grete Moth, MHSc, Ph.D Danish Paediatric Asthma Centre Aarhus University Hospital, Skejby and Research Unit for General Practice University of Aarhus

Insufficient treatment of asthmatic children > quality of life > hospitalisation > high public health expenditures Nationwide registries Background

To examine adherence to guidelines on use of lung function tests in paediatric asthma care - performance of the various care providers - risk of hospitalisation Aim

Methods I Danish Civil Registration System - the personal registration number Register of Medicinal Product Statistics - prescriptions of medicine Danish National Patient Registry - hospitalisations and visits to outpatient clinics National Health Insurance Service Registry - visits to GPs and primary care specialists Statistics Denmark - socioeconomic factors

Methods I Study population: incident asthmatic children aged 6-14 Study period:

Methods I Provider of care: 1.GPs 2.Primary care specialists 3.Hospital specialists 4.GPs and specialists Use of lung functions tests 1.- at start of medication 2.- during months during months 7-12

Results I asthmatic children: Age6-818,025 (49%) ,174 (38%) ,741 (13%) Provider GPs25,966 (70%) Prim.care spec.1,286 (5%) Hosp.spec.2,594 (7%) GPs and spec.7,094 (18%) MedicationInhaled steroid32,693 (89%)

The good news: 5% - no lung function test at all Results I The bad news: 9% - lung function tests as recommended

All three indicators GPs3 % Primary care specialists 16 % Hospital specialists 28 % GPs and specialists 13 % Results I

Indicators: at least one lung function test At start of medication % Months 1-6 % Months 7-12 % In all % GPs Prim.care spec Hosp.spec GPs and spec Results I

Is there a problem? Discussion Lack of adherence to guidelines by GPs - but also by specialists Appropriateness of the guidelines concerning use of lung function test

Methods II Exposure: Lung function test at least once 1.- at start of medication 2.- months months 7-12 Outcome: Risk of hospitalisation

Results II Risk of hospitalisation At least one lung function test: Hazard ratio (95% CI) P-value At start of medication0.64 ( )<0.001 During months ( )0.045 During months ( )0.2

Is there a problem? Perspective It seems so, but.. - Registry data are proxy outcome - Further research on patient centered outcome measures is needed If No >> guideline revision If Yes >> quality development

Thank you for your attention!