CMAJ • April 8, 2008; 178 (8). doi:10.1503/cmaj.070426.
© 2008 Canadian Medical Association or its licensors
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Research

Examining asthma quality of care using a population-based approach

Helena Klomp, RN MSc, Joshua A. Lawson, MSc, Donald W. Cockcroft, MD, Benjamin T. Chan, MD MPH, Paul Cascagnette, BSc, Laurie Gander, RN MN and Derek Jorgenson, PharmD

From the Health Quality Council (Klomp, Cascagnette, Gander), Saskatoon, Sask.; the Canadian Centre for Health and Safety in Agriculture (Lawson), University of Saskatchewan; the Department of Medicine (Cockcroft), University of Saskatchewan, Saskatoon, Sask.; the Ontario Health Quality Council (Chan), Toronto, Ont.; the Department of Pharmaceutical Services (Jorgenson), Saskatoon Health Region, Saskatoon, Sask.

Correspondence to: Helena Klomp, Health Quality Council, Atrium Building, Innovation Place, 241-111 Research Dr., Saskatoon SK S7N 3R2; fax 306 668-8820; hklomp{at}hqc.sk.ca

Background: Asthma accounts for considerable burden on health care, but in most cases, asthma can be controlled. Quality-of-care indicators would aid in monitoring asthma management. We describe the quality of asthma care using a set of proposed quality indicators.

Methods: We performed a retrospective cross-sectional study using health databases in Saskatchewan, a Canadian province with a population of about 1 million people. We assessed 6 quality-of-care indicators among people with asthma: admission to hospital because of asthma; poor asthma control (high use of short-acting β-agonists, admission to hospital because of asthma or death due to asthma); no inhaled corticosteroid use among patients with poor control; at least moderate inhaled corticosteroid use among patients with poor control; high inhaled corticosteroid use and use of another preventer medication among patients with poor control; and any main preventer use among patients with poor control. We calculated crude and adjusted rates with 95% confidence intervals. We tested for differences using the {chi}2 test for proportions and generalized linear modelling techniques.

Results: In 2002/03, there were 24 616 people aged 5–54 years with asthma in Saskatchewan, representing a prevalence of 3.8%. Poor symptom control was observed in 18% of patients with asthma. Among those with poor control, 37% were not dispensed any inhaled corticosteroids, and 40% received potentially inadequate doses. Among those with poor control who were dispensed high doses of inhaled corticosteroids, 26% also used another preventer medication. Hospital admissions because of asthma were highest among those aged 6–9 years and females aged 20–44 years. Males and those in adult age groups (predominantly 20–44 years) had worse quality of care for 4 indicators examined.

Interpretation: Suboptimal asthma management would be improved through increased use of inhaled corticosteroids and preventer medications, and reduced reliance on short-acting β-agonist medications as recommended by consensus guidelines.


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