Treatment of multimorbid asthma patients in structured care. Results from the Disease Management Program (DMP) Bronchial Asthma in the North Rhine region in Germany.

Abstract

Introduction and Objectives: Asthma is one of the most common chronic disorders. Besides asthma, there are disease management programs (DMP) for COPD, CHD, diabetes type I & II and breast cancer in Germany, focusing on patient education (internal DMP), standardized documentation and optimization of quality of care. The emphasis of this study is to analyze if asthma patients who also suffer for other chronic diseases have a lower chance to gain the quality objectives in the asthma program. Methods: Medical records from general practitioners and pneumologists in the ambulatory setting were used. A logistic regression analysis was conducted for all adult DMP participants. Results: In 2016 20.228 from 93.357(22 %) asthma patients were also monitored in other DMP. Patients who are only in the DMP Asthma are younger compared to multimorbid patients (51.4 vs. 64.8 years). Moreover, they achieve more often a good asthma control (89.2 vs. 88.9%), avoid more often ED visits (99.4 vs. 99.2%), get more often a written action plan (65.6 vs. 61.9%), get more often an ICS as controller medication (85.1 vs. 81.7%), attend more often a patient education (52.0 vs. 50.6%) and the inhalation technique is more often checked (77.1 vs. 74.0%) compared to patients that take part in more than one program. In the multivariate model the patients who also take part in other DMP show under control for age, sex, smoker status and medication a lower chance to gain asthma control (Odds Ratio (OR) up to 0.42; [0.27-0.67] for patients that participate in four DMP). Conclusion: Obviously multimorbid asthma patients need more attention in achieving treatment goals.