The costs of implementing the 1999 Canadian Asthma Consensus Guidelines recommendation of asthma education and spirometry for the family physician.
BACKGROUND
National and international asthma guidelines recommend that patients with asthma be provided with asthma education and spirometry as a component of enhanced asthma care. The cost of implementing these interventions in family physician practices is not known.


OBJECTIVE
The objective of the present study was to determine the cost of providing recommended asthma care to adult patients in the family practice setting.


METHODS
The present study was conducted using three scenarios of care in family practice. Small, medium and large asthmatic patient populations were used. The incremental costs of implementing enhanced asthma care based on the Canadian Asthma Consensus Guidelines, including the provision of spirometry and asthma education in both group and individual sessions, and the resources required for these interventions were calculated for each scenario.


RESULTS
For a physician with 50 asthmatic patients, the cost of providing enhanced asthma care with spirometry and group education sessions was approximately 78 dollars per patient in the first year of implementation. For individual sessions, the cost increased to 100 dollars per patient for the first year. If the physician had 100 asthmatic patients, the per patient cost would decrease; however, the overall cost of the program would be 7,000 dollars.


CONCLUSIONS
The costs of providing enhanced asthma care are significant. In most cases, physicians are inadequately reimbursed (or not reimbursed) for these interventions. In light of the evidence of the effectiveness of these interventions, health insurance plans should consider adding these services to fee schedules.
University of British Columbia, Vancouver.
Susan P
SP
Corrigan
David L
DL
Cecillon
Don D
DD
Sin
Heather M
HM
Sharpe
Elaine M
EM
Andrews
Robert L
RL
Cowie
S F Paul
SF
Man
D001249:Asthma / Q000175:diagnosis / Q000191:economics*; D002170:Canada; D004502:Education, Medical, Continuing / Q000191:economics*; D005194:Family Practice / Q000191:economics* / Q000592:standards; D019983:Guideline Adherence / Q000191:economics*; D017048:Health Care Costs; D006287:Health Planning Guidelines; D006801:Humans; D017410:Practice Guidelines as Topic; D013147:Spirometry / Q000191:economics*