1. 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

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

3. 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

4. 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

5. Methods I Study population: incident asthmatic children aged 6-14 Study period: 1999-2004

6. 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 1-6 3.- during months 7-12

7. Results I 36.940 asthmatic children: Age6-818,025 (49%) 9-1114,174 (38%) 12-144,741 (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%)

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

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

10. Indicators: at least one lung function test At start of medication % Months 1-6 % Months 7-12 % In all % GPs 3430113 Prim.care spec. 100523216 Hosp.spec.100575428 GPs and spec. 42776113 Results I

11. 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

12. Methods II Exposure: Lung function test at least once 1.- at start of medication 2.- months 1-6 3.- months 7-12 Outcome: Risk of hospitalisation

13. Results II Risk of hospitalisation At least one lung function test: Hazard ratio (95% CI) P-value At start of medication0.64 (0.55-0.74)<0.001 During months 1-60.82 (0.68-1.00)0.045 During months 7-121.17 (0.92-1.50)0.2

14. 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

15. Thank you for your attention!