Family Medicine Update

Adherence of primary care physicians in Aseer region, Saudi Arabia to the National Protocol for the Management of Asthma.

East Mediterr Health J. 2010 Feb;16(2):171-5

Authors: Abudahish A, Bella H

To determine adherence of primary health care (PHC) physicians to the National Protocol for the Management of Asthma and barriers affecting adherence, we conducted a cross-sectional study in Aseer region, Saudi Arabia. Sixty-one PHC physicians completed self-administered questionnaires on the protocol recommendations. We also checked 212 medical records for adherence. Despite high awareness among the physicians, adherence to the protocol was low: perceived barriers included lack of essential medications, insufficient time and lack of training on the protocol. We recommend establishing a new strategy for effective training of PHC physicians on the protocol.

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– Adherence of primary care physicians in Aseer region, Saudi Arabia to the National Protocol for the Management of Asthma.

Misdiagnosis of patients receiving inhaled therapies in primary care.

Int J Chron Obstruct Pulmon Dis. 2010;5:241-9

Authors: Izquierdo JL, Martín A, de Lucas P, Rodríguez-González-Moro JM, Almonacid C, Paravisini A

AIM: To analyze the accuracy of diagnosis in a population receiving inhaled therapies due to respiratory diseases in a primary care setting. METHOD: Noninterventional, multicenter, cross-sectional, observational epidemiologic study methodology. RESULTS: A total of 9752 subjects were evaluated. Of these, 4188 (42.9%) patients were diagnosed with asthma, 4175 (42.8%) with chronic obstructive pulmonary disease (COPD), and 1389 had a diagnosis of disease of unknown origin. Of those over the age of 40 years, 4079 (50.9%) had COPD and 2877 (35.9%) had asthma. Sixty percent of the subjects were men, and the proportion of men was higher in patients with COPD (83.2%) than in the group with asthma (39.8%, P < 0.0001). Of subjects with COPD, 17.3% had mild, 55.3% had moderate, 24.1% had severe, and 3.2% had very severe disease. With regard to the level of severity of asthma, 34.9% of subjects had intermittent, 34.6% had mild persistent, 27.1% had moderate persistent, and 3.5% had severe persistent disease. Only 13.9% of patients in the COPD group had all the characteristics of COPD based on the Global Initiative for Chronic Obstructive Lung Disease criteria and an absence of the characteristics of asthma. CONCLUSIONS: The majority of patients receiving inhaled therapy in primary care did not have an accurate diagnosis according to current international guidelines for COPD and asthma. More initiatives for improving diagnostic accuracy in respiratory diseases must be implemented in primary care.

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– Misdiagnosis of patients receiving inhaled therapies in primary care.

Use of the inhaled corticosteroid to bronchodilator ratio in an audit of the treatment of asthma in an academic family medicine residency programme.

J Prim Health Care. 2010 Mar;2(1):22-8

Authors: Pisarik P

INTRODUCTION: Asthma affects around 5% of the United States population, with 50% having uncontrolled symptoms. AIM: To improve asthma care by seeing if the inhaled corticosteroid to bronchodilator ratio (RATIO) is associated with asthma control and if non-clinical factors were associated with adherence to asthma guidelines. METHOD: A retrospective study using University of Oklahoma-Tulsa, School of Community Medicine Family Medicine Clinic electronic medical records of a random sample of 49 patients with asthma who were seen at least twice from July 2003 through June 2007 and did not have a diagnosis of chronic obstructive pulmonary disease or exercise-induced asthma. RESULTS: The RATIO for those prescribed corticosteroid inhalers was directly related to the actual step of asthma care (STEP) but inversely related to the number of prednisone courses prescribed per year (R2 =.30, p = 0.0012). The difference between the actual STEP and ideal STEP (had corticosteroid inhalers been prescribed for all the months in the study) was directly related to the percent of available salbutamol (albuterol) inhalersthat non-clinicians refilled and inversely related to the actual STEP (R2 = .45, p = 1.8 x 10(-5)). The available corticosteroid inhalers prescribed was directly related to the actual STEP and inversely related to the number of comorbid diagnoses addressed at the last asthma visit (R2 = .70, p = 5.8 x 10(-10)). DISCUSSION: Efforts to both limit salbutamol medications, especially by non-clinicians, and simultaneously prescribe appropriate amounts of inhaled corticosteroids, through a dedicated asthma visit, should improve asthma control. A higher RATIO implies better asthma control.

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– Use of the inhaled corticosteroid to bronchodilator ratio in an audit of the treatment of asthma in an academic family…