Robert S Zeiger1, Michael Schatz2, Qiaowu Li2, Paul G Solari3, James L Zazzali3, Wansu Chen2. 1. Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif. Electronic address: robert.s.zeiger@kp.org. 2. Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif. 3. Genentech Inc, South San Francisco, Calif.
Abstract
BACKGROUND: Excessive use of short-acting β2-agonists (SABA) indicates impaired asthma control. OBJECTIVE: To determine whether real-time outreach to excessive SABA users reduces SABA canister dispensings. METHODS: After real-time determination of a seventh SABA canister dispensing in the prior 12 months by using informational pharmacy technology, 12 to 56 year old patients with physician-coded asthma and inhaledcorticosteroid dispensing were block randomized by prior asthma specialist care and medication step-care level into intervention (n = 1001) and control groups (n = 998). Intervention included real-time letter notification to patients and an electronic message to their physician with management suggestions, including facilitated allergy referral for patients without prior asthma specialist care. The control group received this organization's standard asthma care management without research contact. Frequency of the seventh SABA canister dispensing in the follow-up year was the primary outcome. RESULTS: Compared with controls, intervention patients reached 7 SABA canister dispensings less frequently (50.7% vs 57.1%; risk ratio 0.89 [95% CI, 0.82-0.97]; P = .007) and later (hazard ratio 0.80 [95% CI, 0.71-0.91; P < .001). SABA canister dispensings (mean ± SD) were less in intervention (7.5 ± 4.9 canisters) than controls (8.6 ± 5.3 canisters) (rate ratio 0.87 [95% CI, 0.82-0.93]; P < .001). The intervention reduced the risk of ≥7 SABA canister dispensings in patients without specialist care compared with patients with specialist care in the prior 3 years (P < .001) (P = .04 for interaction by prior specialist care). Visits to allergists were more frequent for intervention patients (30.9%) than for control patients (16.8%) (risk ratio 1.83 [95% CI, 1.54-2.16]; P < .001). Asthma exacerbations were unaffected. CONCLUSIONS: A novel administrative-based asthma outreach program improves markers of asthma impairment in patients without prior asthma specialist care and is adaptable to managed care organizations with electronic medical records.
RCT Entities:
BACKGROUND: Excessive use of short-acting β2-agonists (SABA) indicates impaired asthma control. OBJECTIVE: To determine whether real-time outreach to excessive SABA users reduces SABA canister dispensings. METHODS: After real-time determination of a seventh SABA canister dispensing in the prior 12 months by using informational pharmacy technology, 12 to 56 year old patients with physician-coded asthma and inhaled corticosteroid dispensing were block randomized by prior asthma specialist care and medication step-care level into intervention (n = 1001) and control groups (n = 998). Intervention included real-time letter notification to patients and an electronic message to their physician with management suggestions, including facilitated allergy referral for patients without prior asthma specialist care. The control group received this organization's standard asthma care management without research contact. Frequency of the seventh SABA canister dispensing in the follow-up year was the primary outcome. RESULTS: Compared with controls, intervention patients reached 7 SABA canister dispensings less frequently (50.7% vs 57.1%; risk ratio 0.89 [95% CI, 0.82-0.97]; P = .007) and later (hazard ratio 0.80 [95% CI, 0.71-0.91; P < .001). SABA canister dispensings (mean ± SD) were less in intervention (7.5 ± 4.9 canisters) than controls (8.6 ± 5.3 canisters) (rate ratio 0.87 [95% CI, 0.82-0.93]; P < .001). The intervention reduced the risk of ≥7 SABA canister dispensings in patients without specialist care compared with patients with specialist care in the prior 3 years (P < .001) (P = .04 for interaction by prior specialist care). Visits to allergists were more frequent for intervention patients (30.9%) than for control patients (16.8%) (risk ratio 1.83 [95% CI, 1.54-2.16]; P < .001). Asthma exacerbations were unaffected. CONCLUSIONS: A novel administrative-based asthma outreach program improves markers of asthma impairment in patients without prior asthma specialist care and is adaptable to managed care organizations with electronic medical records.
Authors: Nicole M Wagner; Debra P Ritzwoller; Marsha A Raebel; Glenn K Goodrich; Peter J Cvietusa; Diane K King; Jo Ann Shoup; Bruce G Bender Journal: Transl Behav Med Date: 2021-04-07 Impact factor: 3.046
Authors: Shauna McKibben; Anna De Simoni; Andy Bush; Mike Thomas; Chris Griffiths Journal: NPJ Prim Care Respir Med Date: 2018-04-16 Impact factor: 2.871
Authors: Linda Kwakkenbos; Mahrukh Imran; Stephen J McCall; Kimberly A McCord; Ole Fröbert; Lars G Hemkens; Merrick Zwarenstein; Clare Relton; Danielle B Rice; Sinéad M Langan; Eric I Benchimol; Lehana Thabane; Marion K Campbell; Margaret Sampson; David Erlinge; Helena M Verkooijen; David Moher; Isabelle Boutron; Philippe Ravaud; Jon Nicholl; Rudolf Uher; Maureen Sauvé; John Fletcher; David Torgerson; Chris Gale; Edmund Juszczak; Brett D Thombs Journal: BMJ Date: 2021-04-29