To collect national baseline information on asthma management practices by physicians, and to compare these practices with the recommendations of the Canadian Asthma Consensus Conference ('the guidelines').
Cross-sectional survey of representative samples of physicians in Canada in late 1996 and early 1997.
Five specialty types of physicians who manage asthma patients: respirology, pediatrics, internal medicine, allergy and clinical immunology, and general practice and family medicine. Stratified sampling by province and specialty was used to select physicians for the study. Weighting was used in the analysis to generalize the results to the national level for the five specialty groups of physicians.
Mailed questionnaire, self-administered by the respondent; three mailings of the questionnaires were used to increase the response rate.
The frequency with which each of the five specialty types chose specific asthma management choices was determined, using weighted percentages representative of the specialty groups on a national basis. ANOVA determined the statistically significant differences among the five specialties in choosing particular asthma management actions. Then, logistic regression was used to calculate the odds ratios showing an association between the characteristics of the physician respondents and specific asthma management choices that they made in the survey.
The data analysis demonstrated significant variations among physicians in asthma management practices, according to specialty type and other characteristics. The initial report was released in April 1998, and manuscripts for journal submissions are being prepared.
What determines access to the Voksentoppen Children's Asthma and Allergy Centre, the most specialized health care facility for asthmatic children in Norway? This publicly funded national institution is mandated to serve all segments of the population equally. The paper reports from the experiences of families with children having a confirmed diagnosis of moderate to severe asthma. The study population was selected from a national register of state cash-benefit recipients. Within this register, all families with a child under the age of 9 and with the diagnosis of asthma at the end of 1997 were selected (N = 2564). Further information about the population was gathered in a postal survey. It was found that access to the facility, measured as at least one admission during the period of the disease, was primarily determined by variations in morbidity. In particular, measures of health condition that presupposed a professional's evaluation of the child's health condition were significant. In addition, access was influenced by several factors not directly related to the need for treatment. Notably, children from families in which parents had a graduate education were over-represented among those with access to the top level of the institution's medical hierarchy. Multivariate analysis was used to search for causal mechanisms. It was found that families with a doctor in their social network had greater likelihood of access, and this in part accounted for the observed association between education and access. The pattern of access was also influenced by geographical factors, but not in a way that reduced the significance of educational background. Membership of, and participation in, patient organizations also increased the families' chances of receiving top-level professional treatment. The results depart from professional norms and officially stated health policy in Norway, which assert that health condition is the only valid criterion for allocating scarce medical goods.
Asthma exacerbations constitute one of the most common causes of emergency department (ED) attendance in most developed countries. While severe asthma often requires hospitalization, variability in admission practices has been observed.
To describe the factors associated with admission to Canadian hospitals for acute asthma after ED treatment.
Subjects 18 to 55 years of age treated for acute asthma in 20 Canadian EDs prospectively underwent a structured ED interview (n=695) and telephone interview two weeks later.
The median age of the patients was 30 years, and the majority were women (62.8%). The admission rate was 13.1% (95% CI 10.7% to 15.8%). Admitted patients were older, more often receiving oral or inhaled corticosteroids at presentation, and more frequently receiving systemic corticosteroids and magnesium sulphate in the ED. Similar proportions received beta-2 agonists and/or ipratropium bromide within 1 h of arrival. On multivariable analyses, factors associated with admission included age, previous admission in the past two years, more than eight beta-2 agonist puffs in the past 24 h, a Canadian Triage and Acuity Score of 1 to 2, a respiratory rate of greater than 22 breaths/min and an oxygen saturation of less than 95%.
The admission rate for acute asthma from these Canadian EDs was lower than reported in other North American studies. The present study provides insight into practical factors associated with admission for acute asthma and highlights the importance of history and asthma severity markers on ED decision making. Further efforts to standardize ED management and expedite admission decision-making appear warranted.
Cites: Am J Epidemiol. 1998 Oct 1;148(7):666-709778173
The association between lower socioeconomic status and poorer health outcomes has been observed using both individual-level and aggregate-level measures of income and education. While both are predictive of health outcomes, previous research indicates poor agreement between individual-level and aggregate-level measures. The purpose of this study was to determine the level of agreement between aggregate-level and individual-level measures of income and education among three distinct patient groups, specifically asthma, diabetes, and rheumatoid patients.
Individual-level measures of annual household income and education were derived from three separate surveys conducted among patients with asthma (n = 359), diabetes (n = 281) and rheumatoid arthritis (n = 275). Aggregate-level measures of income and education were derived from the 2001 Canadian census, including both census tract-and dissemination area-level measures. Cross-tabulations of individual-level income by aggregate-level income were used to determine the percentage of income classifications in agreement. The kappa statistic (simple and weighted), Spearman's rank correlations, and intra-class correlation coefficient (ICC) were also calculated. Individual-level and aggregate-level education was compared using Chi-Square tests within patient groups. Point biserial correlation coefficients between individual-level and aggregate-level education were computed.
Individual-level income was poorly correlated with aggregate-level measures, which provided the worst estimations of income among patients in the lowest income category at the individual-level. Both aggregate-level measures were best at approximating individual-level income in patients with diabetes, in whom aggregate-level estimates were only significantly different from individual-level measures for patients in the lowest income category. Among asthma patients, the proportion of patients classified by aggregate-level measures as having a university degree was significantly lower than that classified by individual-level measures. Among diabetes and rheumatoid arthritis patients, differences between aggregate and individual-level measures of education were not significant.
Agreement between individual-level and aggregate-level measures of socioeconomic status may depend on the patient group as well as patient income. Research is needed to characterize differences between patient groups and help guide the choice of measures of socioeconomic status.
Two allergen-free wards (AFW) fitted out with Academician I. V. Petryanov's filters have been in operation in the Department of General Allergy of the Institute of Immunology, USSR Ministry of Health, since 1981. A high AFW efficacy was shown during treatment without drugs of pollinosis patients with grave manifestations in the pollination season and patients with atopic bronchial asthma outside the season of plant pollination. Since 1981 treatment in AFW has been provided to 232 patients, of them in 104 with a good effect in the season of plant pollination.
The objective of this study was to document that an observational study decreases the use of the emergency department (ED) for asthma. Comparison of rates between an audit and prospective period were used at a regional referral pediatric hospital ED. A total of 526 asthma visits from February 12, 1992, to April 10, 1992, were examined in an initial audit and compared to 725 visits during a prospective study from May 16, 1993, to September 29, 1993. A physician check list for medications and follow-up plans was utilized during the prospective study. The rate of repeat visits and admissions was compared between the audit and the prospective periods. In the audit, 422 asthma patients were seen, and there were 68 repeat visits within one week of the initial visit and 153 admissions. For 29 of the 68 repeat visits there was no documentation that medication had been increased after the initial visit. No follow-up plans were recorded in 275 of the 526 visits. During the prospective period 668 children presented to the ED with asthma, and 346 were enrolled into the study on risks for repeat visits. There were 57 repeat visits and 89 admissions. The repeat visit rate during the prospective period was 9 and 8%, respectively, in the enrolled and nonenrolled subjects. The repeat visit and admission rate decreased during the prospective period as compared to during the audit by 39% (P = 0.004) and 58% (P
INTRODUCTION: In Denmark, asthma is the most widespread chronic childhood disease, imposing great demands on the health services. Considerable variations exist among Danish counties with respect to the percentage of asthmatic children treated by general practitioners and paediatric specialists, which makes it relevant to investigate whether there are differences among Danish counties in admission and readmission rates to hospitals in relation to the capacity of the outpatient clinics. MATERIALS AND METHODS: We performed a cross-sectional study using county-level aggregated data derived from the National Hospital Register and from StatBank Denmark documenting hospital admissions and visits to outpatient clinics in 2001 of children aged 0-4 years and 5-14 years with asthma or bronchitis. The chi2-test was used to calculate the differences by county. RESULTS: The results showed statistically significant differences among the counties in hospital admission rates, readmission rates and number of visits to outpatient clinics. DISCUSSION: The differences among counties in admission rates and number of visits to outpatient clinics indicate that there are considerable variations in the amount of specialist resources being allocated to management of childhood asthma. No study results are available about where asthmatic children are treated most advantageously, which makes further research relevant in view of the large differences in use of resources.