HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Halm, E. A. Articles by Leventhal, H. Search for Related Content PubMed PubMed Citation Articles by Halm, E. A. Articles by Leventhal, H.

Quality and Access to Care Among a Cohort of Inner-city Adults With Asthma^*

Who Gets Guideline Concordant Care?

^* From the Division of General Internal Medicine, Department of Medicine (Drs. Halm and Wisnivisky), Mount Sinai School of Medicine, New York, NY; and Institute for Health, Health Care Policy and Aging Research (Dr. Levanthal), Rutgers University, New Brunswick, NJ.

Correspondence to: Ethan A. Halm, MD, MPH, Division of General Internal Medicine, Mount Sinai School of Medicine, Box 1087, One Gustave L. Levy Place, New York, NY 10029; e-mail: ethan.halm{at}mountsinai.org

Study objectives: Asthma morbidity is highest among inner-city populations. This study measured whether quality and access to care over time was concordant with National Asthma Education and Prevention Program (NAEPP) guidelines. It also identified factors associated with NAEPP guideline-concordant care.

Design: A prospective, observational cohort study

Setting: An urban academic medical center.

Patients: A consecutive cohort of 198 inner-city adults hospitalized for asthma.

Measurements: Detailed information about sociodemographics, asthma history, access to care, history of the current exacerbation, prescription and use of inhaled corticosteroids (ICS) and ß-agonists, and other elements of NAEPP-concordant care (spacers, metered-dose inhaler [MDI] technique, peak flow meters, and action plans) was collected during the index admission and 1 month and 6 months after discharge.

Results: In this predominantly low-income, nonwhite cohort, while 92% of patients had insurance and 80% had a usual source of care, 73% reported delays in seeking care. ICS were prescribed for 77% of patients prior to hospital admission, 83% at 1 month, and 67% at 6 months. Adherence with other NAEPP recommendations were 89% for receipt of MDI instruction, 68% for spacers, 80% for peak flow meters, 31% for written action plans for worsening, and 22% for written plans for attacks. In multivariate analysis, greater asthma severity and having a usual source of care increased the odds of receiving ICS, spacers, and peak flow meters. Care by a specialist increased the odds of receiving action plans. Patients who spoke mostly Spanish were less likely to be given spacers or action plans.

Conclusion: Baseline problems with quality and access to care persisted over time. Better systems of care are needed to ensure that high-risk patients receive an appropriate step-up in the quality of ongoing asthma care.

Key Words: access • adherence • asthma • guidelines • management • quality

This article has been cited by other articles:

				E. A. Halm, P. Mora, and H. Leventhal No Symptoms, No Asthma: The Acute Episodic Disease Belief Is Associated With Poor Self-Management Among Inner-City Adults With Persistent Asthma Chest, March 1, 2006; 129(3): 573 - 580. [Abstract] [Full Text] [PDF]