The Role of Primary Care in Asthma Control and Severity

Abstract

Background: Asthma is a common chronic inflammatory disease of the airways affecting 3 million Canadians. Primary Care Providers (PCPs) are integral to care coordination, enhanced through the development of a strong patient-PCP relationship with Continuity of Care (COC). A recent CIHI study noted that 40% of Albertans do not have a COC model for primary care. Objectives: We aim to evaluate how primary care for adults with asthma impacts different measures of control. Methods: Prospective population-based recruitment of adults through various community venues across Alberta. Those who had self-reported asthma and were willing to participate completed a survey which included demographics, comorbidities, medication use (including biologics, allergy medications, steroids), Asthma Control Questionnaire (ACQ-5), Asthma Control Test (ACT), Quality of Life (QoL) measured through the mini-Asthma Quality of Life Questionnaire (mini-AQLQ) and health care utilization (including Emergency Department (ED) visits, hospitalizations and ICU stays for asthma). Results: Of the 1685 individuals approached, 61 (3.6%) reported having asthma, of which 47 lived in Alberta. Most (41, 87%) had a PCP, with 30 (64%) visiting their PCP at least twice a year. Uncontrolled asthma was noted in 21 (45%) with either the ACQ-5 or ACT. The mini-AQLQ indicated 5 (11%) with reduced QoL. Mean lifetime hospitalizations, lifetime Emergency Department (ED) visits, and ICU stays related to asthma were 1.52, 4.55 and 0.25 respectively. Further, mean hospitalizations and ED visits in the past 12 months related to asthma were 0.05 and 0.30 respectively. Conclusions: Asthma control was poor in 21 (45%) surveyed individuals, suggesting sub-optimal asthma management in Alberta. Knowledge of Primary Care Networks (PCNs) was low, while ED and hospital usage was high.