Asthma Management and Control in Canada (The Care Gap)

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Asthma Management and Control in Canada(The Care
Gap)

• The Alberta Strategy To Help Manage Asthma
  (ASTHMA)
• R. L. (Bob) Cowie MD
• Asthma For Africa Congress
• February 2001

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ASTHMA CONTROL

• not needing ß2 agonists gt3 / week (except for
  1/day pre-exercise)
• not waking at night with asthma
• no restriction of daytime activity
• not visiting ED for asthma Rx
• not missing work/school
• normal or near-normal lung function

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Asthma in Canada

• 55 patients experience daily symptoms
• 52 use their rescue medication every day
• 41 use inhaled corticosteroids
• 2 use long acting ?2 agonists
• 
  Canadian Family Physician Vol. 45 July 1999

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Asthma in Canada

• In a national survey conducted by random
  telephone dialling, of 1001 subjects with current
  asthma, 850 (85) indicated that their asthma was
  controlled.
• Asthma in Canada survey, 1999
• Canadian Family Physician Vol. 45 July 1999

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Asthma in Canada

• On the basis of their response to questions about
  their asthma, only 24 were well controlled
  (versus 85 who thought they were controlled)
  using the national consensus definition of
  control published 5 years earlier.
• Asthma in Canada survey, 1999
• Canadian Family Physician Vol. 45 July 1999

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Asthma in Alberta

• In a study of several rural centres in Alberta it
  was found that only 27 had reasonable control of
  their disease

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Asthma in Alberta

• 30 of those with asthma visited an emergency
  department in the last year
• 50 wake at night with asthma
• 50 use rescue medication daily
• 13 missed work or school in the last year

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Poorly controlled Asthma

• Poorly controlled asthma not only has an impact
  on the quality of life and productivity of those
  with the disease, it also consumes excessive
  amounts of health care resources.

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Asthma Costs

• A recent Canadian study estimated the cost per
  annum for one individual with asthma to be 2,550
  (R12,750) which conforms with a national estimate
  of 12,000,000,000 (R60,000,000,000) per year for
  asthma.
• Ungar, Can Respir 19985463
• LCDC Ottawa, Health Canada 1997

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Asthma Costs

• A recent British study showed that costs
  increased by 3.5 times in patients who required
  at least one visit to an emergency/casualty
  department(ED).
• In a US study, Hospital and ED costs accounted
  for 50 of the total
• 
  Hoskins Thorax 20005519
• Weiiss NEJM 1992326862

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Asthma Economics
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A.S.T.H.M.A

• At meetings with representatives from the two
  universities in Alberta and Merck Frosst Canada,
  Merck agreed to fund the development of a
  proposal to improve the quality of life of those
  with asthma in the Province.
  

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A.S.T.H.M.A

• The ASTHMA proposal was developed and approved
  for funding and the first Steering Committee
  meeting was held in November 1999.
  

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A.S.T.H.M.A.

• University of Alberta
• University of Calgary
• Alberta Medical Association
• Alberta Provincial Government, Department of
  Health and Wellness
• Alberta Lung Association
• Merck Frosst Canada

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A.S.T.H.M.A. Participants

• Academia
• Government
• Family and Emergency Medicine
• Pharmacists
• Asthma educators
• Regional representatives
• General population

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ALBERTA STRATEGY TO HELP MANAGE ASTHMA

• PHASE 1
• Collect data to show the size and nature of the
  problem

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A.S.T.H.M.A

• Data collection when completed will include the
  audit of several thousand family physician files
  and is continuing with questionnaires to be
  completed by those with asthma. In addition, the
  Provincial government data base has been analysed
  forasthma-related consultations, costs and
  demographics.

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ALBERTA STRATEGY TO HELP MANAGE ASTHMA

• PHASE 2
• Design and implement interventions to improve
  asthma management and control

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3 TOWN ALBERTA STUDY
CONTROLLED YES NO BASIC
EDUCATION CENTRE 47(27) 127 INTERMEDIATE
EDUCATION CENTRE 9(16) 46 INTENSIVE EDUCATION
CENTRE 32(33) 98 P .09
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INTERVENTIONS

• travelling spirometry and education service
• free medication program
• population support group
• short versus long education program
• emergency department based education
• pharmacy trigger for excess ß2 agonist use

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ALBERTA STRATEGY TO HELP MANAGE ASTHMA

• PHASE 3
• More assessment and intervention

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A.S.T.H.M.A

• A similar project (VESPA) is underway in the
  province of Quebec. VESPA and ASTHMA are
  currently collaborating to produce effective and
  generalisable interventions for asthma in Canada.
  

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Suitable initial interventions will be discussed
at our next Steering Committee meeting to be held
near here in April, 2001