EFFECTS OF IMPLEMENTING THE ASTHMA IMPAIRMENT AND RISK QUESTIONNAIRE (AIRQ) AND AN ASSOCIATED GUIDELINE-BASED ASSESSMENT TOOL ON CLINICAL DECISION-MAKING IN PRIMARY CARE

Abstract

SESSION TITLE: Asthma in Children and AdultsSESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/19/2022 11:15 am - 12:15 pmPURPOSE: 50% of adults and 38% of children with asthma in the US have uncontrolled disease and 60% are seen in primary care. Guidelines can reduce asthma morbidity, but studies show primary care clinicians have less self-efficacy and adherence to guidelines than specialists (Cloutier et al. J Allergy Clin Immunol Pract. 2018;6[3]:886-94). We assessed the effects of implementing AIRQ, a 10-item, yes/no asthma control assessment, and Asthma Checklist, a guidelines-based decision support tool, on management decisions in primary care.METHODS: 351 primary care patients with asthma aged ≥13 yrs participated in a study in which AIRQ and Asthma Checklist were integrated into clinical visits. 201 were in 2 private practices (PP) and 150 in 3 Federally Qualified Health Centers (FQHC) treating the underserved. During the visit, clinicians rated patients’ asthma as completely, well, somewhat, poorly, or not controlled. Demographic and clinical characteristics were compared for PP vs FQHC. Management choices relative to AIRQ score (Well-controlled [WC], 0-1 yes responses; Not Well-controlled [NWC], 2-4; Very Poorly Controlled [VPC], 5-10) were analyzed overall and by practice type (chi square; significance p≤0.05).RESULTS: Patients in PP vs FQHC were older (mean[SD] age 53[17] vs 42[20] yrs) and more were male (32% vs 25%) and commercially (65% vs 26%) vs Medicaid (12% vs 47%) insured (p<0.05 for each). FQHC vs PP patients were more likely to use short-acting bronchodilators alone (64% vs 38%, p<0.001) and less likely to use inhaled corticosteroid-based maintenance therapy (37% vs 54%, p<0.002). Overall, 49% were WC, 36% NWC, and 15% VPC by AIRQ. More PP vs FQHC patients were WC (55% vs 41%) and fewer VPC (11% vs 21%, p<0.05). Clinicians rated 59% of patients as completely/well-controlled (60% PP, 57% FQHC, pNS); however, 13% of these patients reported daily activity limitation from symptoms (10% PP, 18% FQHC; pNS), and 8% reported prior-year oral corticosteroid bursts for asthma (4% PP, 13% FQHC; p<0.03). Therapy was stepped-up for 29% (22% PP, 39% FQHC), 20% were considered for add-on or advanced therapies (6% PP, 39% FQHC), and 5% were referred to a specialist (1% PP, 11% FQHC; p<0.001 for each); the percentage of patients recommended for these Asthma Checklist options increased with worsening AIRQ control category (p<0.001).CONCLUSIONS: AIRQ identified half of all patients as having uncontrolled asthma, with greater morbidity in FQHC vs PP. The clinicians assessed more patients as controlled than AIRQ, which may be due in part to under-recognition of daily impact of asthma and exacerbation history.CLINICAL IMPLICATIONS: Implementing AIRQ and Asthma Checklist was feasible and resulted in management decisions concordant with level of control. Prospective evaluation of patient morbidity and sustainability of AIRQ and Asthma Checklist use will determine if these tools can improve asthma treated in primary care.DISCLOSURES: Advisory Committee Member relationship with AstraZeneca Please note: $20001 - $100000 by David Beuther, value=Consulting feeAdvisory Committee Member relationship with AstraZeneca Please note: 2020-present Added 03/31/2022 by Jo Ann Brooks, value=Consulting feeEmployee relationship with Astrazeneca Please note: >$100000 by James Eudicone, value=SalaryEmployee relationship with Astrazeneca Please note: >$100000 by Hitesh Gandhi, value=SalaryEmployee relationship with AstraZeneca Please note: >$100000 by Ileen Gilbert, value=SalaryStock relationship with AstraZeneca Please note: $20001 - $100000 by Ileen Gilbert, value=StockMy spouse/partner as a Consultant relationship with Abott Please note: $20001 - $100000 by Ileen Gilbert, value=Consulting feeEmployee relationship with AstraZeneca Please note: Ongoing Added 03/30/2022 by Ileen Gilbert, value=SalaryConsultant relationship with AstraZeneca Please note: >$100000 by Gale Harding, value=Consulting feeRemoved 04/13/2022 by Gale HardingConsultant relationship with AstraZeneca Please note: 2019-2022 Added 04/13/2022 by Gale Harding, value=Consulting feeConsultant relationship with AstraZeneca Please note: Jan 2021 to Present Added 04/06/2022 by Mary Ladd, value=Consulting feeCorporate sponsor relationship with Amgen Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/ResearchCorporate sponsor relationship with AstraZeneca Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Aimmune Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Amphastar Please note: 1/1/2022-12/31-2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Bristol Myers Squibb Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/ResearchCorporate sponsor relationship with Genentech Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with GlaxoSmithKline Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with DBV Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Johnson & Johnson Please note: 1/1/2022-12/31-2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Merck Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Novartis Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Regeneron Please note: 1/2/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with PhRMA Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with PCMA Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportCorporate sponsor relationship with Viatris Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research SupportConsultant relationship with Astra Zeneca Please note: $5001 - $20000 by Siddhartha Singh, value=Consulting feeSpeaker/Speaker's Bureau relationship with Astra Zeneca Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Speakers FeesSpeaker/Speaker's Bureau relationship with Washington University in St. Louis Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Speakers FeesSpeaker/Speaker's Bureau relationship with Weill Cornell Medicine Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Speakers FeesBoard Member relationship with International Society of Hypertension in Blacks Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Board MemberBoard Member relationship with The Spanish and Portuguese Synagogue Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Board MemberConsultant relationship with GSK Please note: 2020 - 2022 Added 03/30/2022 by Barbara Yawn, value=Consulting feeAdvisory Committee Member relationship with BI Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=HonorariaAdvisory Committee Member relationship with AZ Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=HonorariaAdvisory Committee Member relationship with TEVA Please note: 11/2019-12/2021 by Barbara Yawn, value=Consulting feeConsultant relationship with Pulmonx Please note: 2021 Added 03/30/2022 by Barbara Yawn, value=Consulting feeAdvisory Committee Member relationship with GSK Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=HonorariaAdvisory Committee Member relationship with TEVA Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=HonorariaConsultant relationship with BI Please note: 2020 - 2022 Added 03/30/2022 by Barbara Yawn, value=Consulting feeConsultant relationship with TEVA Please note: 2020 - 2022 Added 03/30/2022 by Barbara Yawn, value=Consulting feeOther relationship with GSK Please note: 2018 - 2021 Added 03/30/2022 by Barbara Yawn, value=Grant/Research Support SESSION TITLE: Asthma in Children and Adults SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: 50% of adults and 38% of children with asthma in the US have uncontrolled disease and 60% are seen in primary care. Guidelines can reduce asthma morbidity, but studies show primary care clinicians have less self-efficacy and adherence to guidelines than specialists (Cloutier et al. J Allergy Clin Immunol Pract. 2018;6[3]:886-94). We assessed the effects of implementing AIRQ, a 10-item, yes/no asthma control assessment, and Asthma Checklist, a guidelines-based decision support tool, on management decisions in primary care. METHODS: 351 primary care patients with asthma aged ≥13 yrs participated in a study in which AIRQ and Asthma Checklist were integrated into clinical visits. 201 were in 2 private practices (PP) and 150 in 3 Federally Qualified Health Centers (FQHC) treating the underserved. During the visit, clinicians rated patients’ asthma as completely, well, somewhat, poorly, or not controlled. Demographic and clinical characteristics were compared for PP vs FQHC. Management choices relative to AIRQ score (Well-controlled [WC], 0-1 yes responses; Not Well-controlled [NWC], 2-4; Very Poorly Controlled [VPC], 5-10) were analyzed overall and by practice type (chi square; significance p≤0.05). RESULTS: Patients in PP vs FQHC were older (mean[SD] age 53[17] vs 42[20] yrs) and more were male (32% vs 25%) and commercially (65% vs 26%) vs Medicaid (12% vs 47%) insured (p<0.05 for each). FQHC vs PP patients were more likely to use short-acting bronchodilators alone (64% vs 38%, p<0.001) and less likely to use inhaled corticosteroid-based maintenance therapy (37% vs 54%, p<0.002). Overall, 49% were WC, 36% NWC, and 15% VPC by AIRQ. More PP vs FQHC patients were WC (55% vs 41%) and fewer VPC (11% vs 21%, p<0.05). Clinicians rated 59% of patients as completely/well-controlled (60% PP, 57% FQHC, pNS); however, 13% of these patients reported daily activity limitation from symptoms (10% PP, 18% FQHC; pNS), and 8% reported prior-year oral corticosteroid bursts for asthma (4% PP, 13% FQHC; p<0.03). Therapy was stepped-up for 29% (22% PP, 39% FQHC), 20% were considered for add-on or advanced therapies (6% PP, 39% FQHC), and 5% were referred to a specialist (1% PP, 11% FQHC; p<0.001 for each); the percentage of patients recommended for these Asthma Checklist options increased with worsening AIRQ control category (p<0.001). CONCLUSIONS: AIRQ identified half of all patients as having uncontrolled asthma, with greater morbidity in FQHC vs PP. The clinicians assessed more patients as controlled than AIRQ, which may be due in part to under-recognition of daily impact of asthma and exacerbation history. CLINICAL IMPLICATIONS: Implementing AIRQ and Asthma Checklist was feasible and resulted in management decisions concordant with level of control. Prospective evaluation of patient morbidity and sustainability of AIRQ and Asthma Checklist use will determine if these tools can improve asthma treated in primary care. DISCLOSURES: Advisory Committee Member relationship with AstraZeneca Please note: $20001 - $100000 by David Beuther, value=Consulting fee Advisory Committee Member relationship with AstraZeneca Please note: 2020-present Added 03/31/2022 by Jo Ann Brooks, value=Consulting fee Employee relationship with Astrazeneca Please note: >$100000 by James Eudicone, value=Salary Employee relationship with Astrazeneca Please note: >$100000 by Hitesh Gandhi, value=Salary Employee relationship with AstraZeneca Please note: >$100000 by Ileen Gilbert, value=Salary Stock relationship with AstraZeneca Please note: $20001 - $100000 by Ileen Gilbert, value=Stock My spouse/partner as a Consultant relationship with Abott Please note: $20001 - $100000 by Ileen Gilbert, value=Consulting fee Employee relationship with AstraZeneca Please note: Ongoing Added 03/30/2022 by Ileen Gilbert, value=Salary Consultant relationship with AstraZeneca Please note: >$100000 by Gale Harding, value=Consulting fee Removed 04/13/2022 by Gale Harding Consultant relationship with AstraZeneca Please note: 2019-2022 Added 04/13/2022 by Gale Harding, value=Consulting fee Consultant relationship with AstraZeneca Please note: Jan 2021 to Present Added 04/06/2022 by Mary Ladd, value=Consulting fee Corporate sponsor relationship with Amgen Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Corporate sponsor relationship with AstraZeneca Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Aimmune Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Amphastar Please note: 1/1/2022-12/31-2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Bristol Myers Squibb Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Corporate sponsor relationship with Genentech Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with GlaxoSmithKline Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with DBV Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Johnson & Johnson Please note: 1/1/2022-12/31-2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Merck Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Novartis Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Regeneron Please note: 1/2/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with PhRMA Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with PCMA Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Corporate sponsor relationship with Viatris Please note: 1/1/2022-12/31/2022 Added 03/31/2022 by Kenneth Mendez, value=Grant/Research Support Consultant relationship with Astra Zeneca Please note: $5001 - $20000 by Siddhartha Singh, value=Consulting fee Speaker/Speaker's Bureau relationship with Astra Zeneca Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Speakers Fees Speaker/Speaker's Bureau relationship with Washington University in St. Louis Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Speakers Fees Speaker/Speaker's Bureau relationship with Weill Cornell Medicine Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Speakers Fees Board Member relationship with International Society of Hypertension in Blacks Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Board Member Board Member relationship with The Spanish and Portuguese Synagogue Please note: 2021-2022 Added 04/05/2022 by Jonathan Tobin, value=Board Member Consultant relationship with GSK Please note: 2020 - 2022 Added 03/30/2022 by Barbara Yawn, value=Consulting fee Advisory Committee Member relationship with BI Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=Honoraria Advisory Committee Member relationship with AZ Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=Honoraria Advisory Committee Member relationship with TEVA Please note: 11/2019-12/2021 by Barbara Yawn, value=Consulting fee Consultant relationship with Pulmonx Please note: 2021 Added 03/30/2022 by Barbara Yawn, value=Consulting fee Advisory Committee Member relationship with GSK Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=Honoraria Advisory Committee Member relationship with TEVA Please note: 2019 - 2022 Added 03/30/2022 by Barbara Yawn, value=Honoraria Consultant relationship with BI Please note: 2020 - 2022 Added 03/30/2022 by Barbara Yawn, value=Consulting fee Consultant relationship with TEVA Please note: 2020 - 2022 Added 03/30/2022 by Barbara Yawn, value=Consulting fee Other relationship with GSK Please note: 2018 - 2021 Added 03/30/2022 by Barbara Yawn, value=Grant/Research Support