Abstract
A population-based, ecological evaluation was conducted to determine the impact of a regional asthma education centre on reducing asthma-related morbidity and improving the quality of prescribing. The number of emergency department (ED) visits for respiratory-related illness and the prescribing of antiasthmatic medications were monitored during consecutive 18-month pre- and postintervention periods in two communities with similar health care resources. Using defined daily doses, the quality of prescribing was assessed by calculating the ratio of inhaled corticosteroids to inhaled, short-acting beta 2-agonists. The reduction in the rate of respiratory-related ED visits in subjects five to 45 years of age was 410 per 10,000 people and 450 per 10,000 people for the intervention and nonintervention communities, respectively. A significant reduction in the rate of ED visits of 698 per 10,000 people was found for patients aged 35 to 45 years in the intervention community (P<0.05). The reduction achieved statistical significance in the nonintervention community in younger patients: 557 per 10,000 people and 567 per 10,000 people for patients aged five to 14 years and 15 to 24 years, respectively (P<0.05). The ratio of inhaled corticosteroids to inhaled beta 2-agonists increased from 0.47 to 0.78 in the intervention community--a 66% change. However, over the course of the preintervention period, the prescribing ratio was already increasing in this community. The corresponding ratios were 0.47 and 0.53 in the nonintervention community--an increase of 13%. A conclusive association between the establishment of an asthma education centre and changes in health care use or the quality of prescribing could not be demonstrated.
Highlights
A population-based, ecological evaluation was conducted to determine the impact of a regional asthma education centre on reducing asthma-related morbidity and improving the quality of prescribing
Our study did not find a conclusive association between the establishment of the asthma education centre and a reduction in asthma-related morbidity or improvements in prescribing, the use of inhaled corticosteroids continued to increase substantially in the intervention community over the period of time when the asthma education centre was present
The greatest decrease in the rate of respiratory-related emergency department (ED) visits occurred in patients aged 35 to 45 years
Summary
A population-based, ecological evaluation was conducted to determine the impact of a regional asthma education centre on reducing asthma-related morbidity and improving the quality of prescribing. METHODS: The number of emergency department (ED) visits for respiratory-related illness and the prescribing of antiasthmatic medications were monitored during consecutive 18-month pre- and postintervention periods in two communities with similar health care resources. We assessed the population impact of an asthma education centre on reducing the number of respiratory-related emergency department (ED) visits and on improving the quality of prescribing in a rural primary care setting. The Antoine-Labelle region served as the control community and had no formal asthma education centre during the study period except for the customary teaching programs already in place. Such programs included medication teaching in the community pharmacy setting, occasional site visits by respirologists and marketing activities by the various pharmaceutical companies. The average use of corticosteroids was expressed as a proportion of the available treatment days, and the difference between the proportions pre- and postintervention were compared within each community using a test for proportions
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