The effectiveness of this approach has been demonstrated in the development of an asthma center specifically developed to target patients with diffi-cult-to-control asthma. Adult patients with more than two emergency department visits within the last 6 months were referred by their primary care pro-vider. Interventions included an initial evaluation by asthma center personnel, spirometry and skin allergy testing, the development of treatment and follow-up plans after discussion of the patient by team members, extensive patient education, and establishment of a relationship with one of the asthma center nurses and physicians. Statistical analysis was not presented in this abstract report, but some of the results have obvious clinical and economic relevance. An analysis of 125 patients found that 90% rated their visit to the asthma center “very good” or “excellent.” Based on prescriptions filled, there was a reduction in the ratio of (3-agonist use vs inhaled corticosteroid use (ratio of 1.65 before vs 1.05 after). website
Most importantly, there was a decrease with intervention in the number of emergency department visits from 74 to 17 (76% reduction) and the number of hospitalizations from 38 to 4 (89% reduction). These were translated into a reduction in costs of emergency department visits from $34,706 to $7,973, and of inpatient care from $192,926 to $20,309; a total saving of $199,351. In comparison, the cost of the initial visit to the asthma center was $770.26 a update on the program presented further benefits (also no statistical analysis provided). There was a clinically relevant improvement in quality of life from an Asthma Quality of Life Questionnaire score of 3.8 to 5.0 after 6 months in the program (a score of 7 is normal, and a change of at least 1 represents a clinically noticeable moderate change). In addition, patients receiving inhaled corticosteroids increased from 72% at baseline to 82% after 6 months. Baseline compliance was 66%, and this increased to 87% after 6 months. At baseline, no patients used an action plan vs 100% after 6 months. This study demonstrates that a patient-focused approach where time is spent developing relationships, organizing treatment plans and follow-up, and educating patients can improve medical outcomes and costs for patients with asthma who are the most challenging to manage.
Among other points, the workshop participants discussed the following:
• How do we address concerns about adverse events with our patients?
• Do you counsel patients by agreeing on a plan of action (concordance)?
• What are the potential barriers to patient-focused care?