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Asthma Management and Control in Canada (The Care Gap)

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. ASTHMA CONTROL. not needing ß 2 agonists >3 / week (except for 1/day pre-exercise) not waking at night with asthma

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Asthma Management and Control in Canada (The Care Gap)

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  1. 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

  2. ASTHMA CONTROL • not needing ß2 agonists >3 / 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

  3. 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

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

  5. 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

  6. Asthma in Alberta In a study of several rural centres in Alberta it was found that only 27% had reasonablecontrol of their disease

  7. 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

  8. 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.

  9. 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 1998;5:463 LCDC Ottawa, Health Canada 1997

  10. 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 2000;55:19 Weiiss NEJM 1992;326:862

  11. Severe Moderate Mild 10% 54% 20% 33% 70% 13% Proportion of Patients Proportion of Cost Asthma Economics

  12. 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.

  13. 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.

  14. 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

  15. A.S.T.H.M.A. Participants • Academia • Government • Family and Emergency Medicine • Pharmacists • Asthma educators • Regional representatives • General population

  16. ALBERTA STRATEGY TO HELP MANAGE ASTHMA PHASE 1 Collect data to show the size and nature of the problem

  17. 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.

  18. ALBERTA STRATEGY TO HELP MANAGE ASTHMA PHASE 2 Design and implement interventions to improve asthma management and control

  19. 3 TOWN ALBERTA STUDY CONTROLLEDYES NO BASIC EDUCATION CENTRE 47(27%) 127 INTERMEDIATE EDUCATION CENTRE 9(16%) 46 INTENSIVE EDUCATION CENTRE 32(33%) 98 P = .09

  20. 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

  21. ALBERTA STRATEGY TO HELP MANAGE ASTHMA PHASE 3 More assessment and intervention

  22. 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.

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

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