Abstract
BackgroundAssessing asthma control using standardised questionnaires is recommended as good clinical practice but there is little evidence validating their use within primary care. There is however, strong empirical evidence to indicate that age, weight, gender, smoking, symptom pattern, medication use, health service resource use, geographical location, deprivation, and organisational issues, are factors strongly associated with asthma control. A good control measure is therefore one whose variation is most explained by these factors.MethodEight binary (Yes = poor control, No = good control) models of asthma control were constructed from a large UK primary care dataset: the Royal College of Physicians 3-Questions (RCP-3Qs); the Jones Morbidity Index; three composite measures; three single component models. Accounting for practice clustering of patients, we investigated the effects of each model for assessing control. The binary models were assessed for goodness-of-fit statistics using Pseudo R-squared and Akaikes Information Criteria (AIC), and for performance using Area Under the Receiver Operator Characteristic (AUROC). In addition, an expanded RCP-3Q control scale (0-9) was derived and assessed with linear modelling. The analysis identified which model was best explained by the independent variables and thus could be considered a good model of control assessment.Results1,205 practices provided information on 64,929 patients aged 13+ years. The RCP-3Q model provided the best fit statistically, with a Pseudo R-squared of 18%, and an AUROC of 0.79. By contrast, the composite model based on the GINA definition of controlled asthma had a higher AIC, an AUROC of 0.72, and only 10% variability explained. In addition, although the Peak Expiratory Flow Rate (PEFR) model had the lowest AIC, it had an AUROC of 71% and only 6% of variability explained. However, compared with the RCP-3Qs binary model, the linear RCP-3Q Total Score Model (Scale 0-9), was found to be a more robust 'tool' for assessing asthma control with a lower AIC (28,6163) and an R-squared of 33%.ConclusionIn the absence of a gold standard for assessing asthma control in primary care, the results indicate that the RCP-3Qs is an effective control assessment tool but, for maximum effect, the expanded scoring model should be used.
Highlights
Assessing asthma control using standardised questionnaires is recommended as good clinical practice but there is little evidence validating their use within primary care
In the absence of a gold standard for assessing asthma control in primary care, the results indicate that the Royal College of Physicians 3-Questions (RCP-3Qs) is an effective control assessment tool but, for maximum effect, the expanded scoring model should be used
From the 10,432 primary care practices in the UK, 1,205 practices of all sizes and with a wide geographical spread, submitted usable practice data and data on 64,929 patients who attended for a routine asthma review
Summary
Assessing asthma control using standardised questionnaires is recommended as good clinical practice but there is little evidence validating their use within primary care. To achieve the guideline standards for asthma there is a necessity for primary health care professionals to efficiently assess and monitor symptom control. To do this they must utilise questions and tools. The complexity and variability of asthma makes prediction of treatment response difficult [4] With such a complex disease, no single parameter can accurately classify and assess control in all individuals [5]. The concern is that patients, and health professionals, often have a different understanding of the language used to describe control [6] This creates a dilemma for those trying to improve the assessment and management of asthma
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.