Statement of Principle Findings

110 Improving Asthma Care in Ministry of Health Primary Care Clinics changes in asthma control over time in patients new to the care of asthma specialists. A cutoff score of 19 or less identifies patients with poorly controlled asthma. In a clinical setting the ACT should be a useful tool to help physicians identify patients with uncontrolled asthma and facilitate their ability to follow patients’ progress with treatment. Wechsler ME. The introduction of handy asthma control handbook in this study to provide information and knowledge to the patient besides asthma record treatment book served as tools for self empowerment for both the patient and health care provider. Written asthma action plans WAAPs are recommended by national and international guidelines to help patients recognize and manage asthma exacerbations. It is found that the key elements of an effective WAAP, including concise, detailed recommendations regarding asthma exacerbation recognition patient self monitoring and treatment Matthew et al. 2008. Although several versions of the WAAP exist, all share certain features. In this study by introducing the asthma handbook patients and the health care provider needed to know that they have to monitor their symptoms or peak expiratory flow PEF to detect deviations from the usual state of controlled asthma. Reminders of warning signs and symptoms as well as potential precipitating factors or personal triggers were included. By incorporating the ACT score as a guide for patient-initiated treatment, options to restore control were explicitly provided in writing. In addition danger signs and contact information were included. This information was documented in the handbook for the patient reference at all time. This study obtained data on asthma control as opposed to previous studies that mainly focused on asthma severity. The lack of a control group hampered comparison and historical internal controls were used. It was felt that it is not acceptable to use a control group as patient identified with uncontrolled asthma could not be left without intervention in the exiting health care provision environment. The sampling was convenient quota sampling but every patient identified in all 6 clinics were included and offered intervention. There was a large dropout of patients 22.9 despite attempts to trace them by phone. However analysis showed that those who dropped out were similar in socio- demographic characteristic. The diagnosis of asthma in this study was based on healthcare provider clinic judgment and not on any objective criteria.