title: Treating asthma by the guidelines: developing a medication management information system for use in primary care.
abstract: The aim of this study was to develop, implement, and assess an automated asthma medication management information system (MMIS) that provides patient-specific evaluative guidance based on 1997 NAEPP clinical consensus guidelines. MMIS was developed and implemented in primary care settings within a pediatric asthma disease management program. MMIS infrastructure featured a centralized database with Internet access. MMIS collects detailed patient asthma medication data, evaluates pharmacotherapy relative to practitioner-reported disease severity, symptom control and model of guideline-recommended severity-appropriate medications and produces a patient-specific "curbside consult" feedback report. A system algorithm translates actual detailed medication data into actual severity-specific medication-class combinations. A table-driven computer program compares actual medication-class combinations to a guideline-based medication-class combinations model. Methodology determines whether the patient was prescribed a "severity-appropriate" amount or an amount "more" or "less" medication than indicated for patient's reported severity. Feedback messages comment on comparison. Missing data, unrecognized amounts of controller medication or unrecognized medication combinations create error cases. Post hoc review analyzed error cases to determine prevalence of non-guideline medicating practices among these practitioners. Proportion of valid and error cases across two clinical visits before and after post hoc clinical review were measured, as well as proportion of severity-appropriate, out-of-severity and non-guideline medications. MMIS produced a valid feedback report for 83% of patient visits. Missing data accounted for 60% of error cases. Practitioners used severity-appropriate medications for 60% of cases. When non-severity-appropriate medications were used they tended to be "too much" rather than "too little" (22%, 5%), suggesting appropriate use of guideline-recommended "step down" therapy by these practitioners.
authors.affiliation: Department of Sociology, Anthropology and Social Work, Kansas State University, Manhattan, Kansas, USA. jetwiggs@netplex.net
authors.forename: Joan E
authors.initials: JE
authors.lastname: Twiggs
authors.forename: J
authors.initials: J
authors.lastname: Fifield
authors.forename: E
authors.initials: E
authors.lastname: Jackson
authors.forename: R
authors.initials: R
authors.lastname: Cushman
authors.forename: A
authors.initials: A
authors.lastname: Apter
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D020000:Decision Support Systems, Clinical; D019468:Disease Management; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States
chemical_list: D018927:Anti-Asthmatic Agents