112
Improving Asthma Care in Ministry of Health Primary Care Clinics
A population-based study on treatment adequacy and the control of asthma de Marco R et al. 2005 has noted that despite the increase in the use of inhaled
corticosteroids, half of the persistent asthmatics from the general population are using a medication regimen below their severity level with 48 of persistent
asthmatics receiving inadequate treatment and 66 did not use their medication daily.
In the Expert Panel Report 3 EPR-3: Guidelines for the Diagnosis and Management of Asthma–Summary Report 2007 confirms the importance of teaching patients skills
to self-monitor and manage asthma and to use a written asthma action plan, which should include instructions for daily treatment and ways to recognise and handle
worsening asthma. The intervention package used in this study accommodates these concepts. In REACT study it is reported that large proportion of patients with
controlled asthma 74 and patients with uncontrolled asthma 65 reported never receiving an asthma action plan. Written asthma action plans are recommended by
national and international guidelines to help patients recognize and manage asthma exacerbations. The key elements of an effective written asthma action plans include
concise, detailed recommendations regarding asthma exacerbation recognition, patient self monitoring and treatment. Matthew AR et al. 2008.
In this study asthma control status post intervention were also gathered through telephone interviewed. Kosinski et al. 2009 has found that ACT scores from a
telephone interview are reliable and comparable to ACT scores from a self- administered paper-and-pencil format.
5.4 Meaning of the Study Possible Mechanisms and Implication for Policy Makers Clinicians
This study has shown that only one third of the asthmatics on follow up at government primary care clinic have their asthma controlled. There is an urgent need to improve
this status. Use of the intervention package from this study may be useful to increase the level of asthma control to at least half. Patient empowerment must be included
in any initiative to improve asthma control.
Although 67.5 of patients were on preventer medication at baseline this did not translate to control in all of them possibly because they were used incorrectly,
inadequate dose or were inappropriate required more effective preventer medication.
113
Improving Asthma Care in Ministry of Health Primary Care Clinics
6.0 CONCLUSION RECOMMENDATIONS
This study has shown that only one third of the asthmatics were controlled at baseline.
The overall rate of asthmatic control for those patients who complete the intervention improved from 39.7 95 CI 35 – 44 to 52.9 95 CI 49-57. Furthermore
proportion of patients with uncontrolled asthma reduced from 25.6 95 CI 22- 29 to 13.8 95 CI 11-17. Use of preventer medication increased from 67.5 to
85.9. After the intervention, the asthmatic control among those of Indian ethnicity and those aged 41-50 years has shown a significant degree of improvement. The
intervention package used in this study is effective in improving asthma control.
Recommendations: 1.
Asthma control is poor with only one third of the asthmatics controlled in primary care clinics. There is need to improve the level of control in patients.
2. The intervention package used in this study is effective in improving asthmatic
controlled. It was based on the CPG with modification with ACT patient handbook included to provide self empowerment. It is recommended that
this intervention package be used to improve asthma control in primary care clinics in Perak and wider.
REFERENCES
1. Asthma education and patient monitoring, Canadian medical association 1999.
Available from: http:www.cmaj.cacgicontentfull 2.
Bateman ED et al.2007. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008; 31:143-178
3. Buist AS, William MV., Sandra RW, E. Ann Frazier, Arthur D.H. 2006. A Randomized
Clinical Trial of Peak Flow versus Symptom Monitoring in Older Adults with Asthma. Am Journal of Resp and crit care med, Vol 174. pp. 1077-1087.
4. CaressA.L,,Luker,K.,Baver,K.,Woodcock,A.2002. Adherence to peak low monitoring.
Information provided by meters should be part of self management plan.BMJ. ; 3247346:1157.
5. Cazzoletti L, Marcon A, Janson C, Corsico A, et.al.2007. Asthma Control in Europe:
A real-world evaluation based on an international population-based study.J of Allergy Clin. Immuno 1206:1360-1367.
6. Clinical practice guidelines for management of adult asthma. Ministry of Health
Malaysia 2002 7.
de Marco R, Cazzoletti L, Cerveri I, Corsico A et al. 2005.Are the Asthma Guideline Goals Achieved in Daily Practice? A Population-Based Study on Treatment Adequacy
and the Control of Asthma. Int Arch Allergy Immunol;138:225-234.
