title: Improving the quality of care of patients with asthma: the example of patients with severely symptomatic disease.
abstract: The increasing economic burden of asthma care is incurred partly by patients with more severe symptoms. However, little is known about the characteristics of these severe asthma patients. This study examined sociodemographic, disease-specific characteristics and health care utilization that are related to asthma disease severity, for the purpose of identifying areas for treatment improvement. A total of 2927 asthma patients (12 years or older), who were continuously enrolled in one of three participating health plans for a 6-month study period and who responded to an asthma survey, were included in the study. Univariate and multivariate analyses were performed to examine the sociodemographic, disease-specific characteristics and health care utilization by asthma severity. About 25% of the patients reported experiencing severe asthma symptoms. They were more likely to be African-Americans, Hispanics, women, patients with less than a college education, residents in the south-west, current smokers, and those receiving care from non-specialists. Severe asthmatics reported having less of an understanding of the clinical manifestation of asthma and the means to manage asthma exacerbation. Outpatient contacts did not differ significantly between severe and other patients, although their utilization of emergency room and inpatient care was significantly greater. This study suggests that a significant proportion of asthma patients is experiencing severe symptoms and barriers other than access to care prevent appropriate control of asthma. Poor control appears to be related to smoking, deficits in knowledge about self-care, not receiving medical care from a specialist, and inadequate use of medications.
authors.affiliation: Health Benchmarks Inc., Woodland Hills, CA 91367, USA.
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.forename: R
authors.initials: R
authors.lastname: Farinpour
authors.forename: C
authors.initials: C
authors.lastname: Sennett
authors.forename: B W
authors.initials: BW
authors.lastname: Bowers
authors.forename: A P
authors.initials: AP
authors.lastname: Legorreta
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011787:Quality of Health Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014481:United States