title: Impact of the Singapore National Asthma Program (SNAP) on preventor-reliever prescription ratio in polyclinics.
abstract: BACKGROUND
  The Singapore National Asthma Program (SNAP) was launched in 2001 to address the high burden of asthma in Singapore. One component of the SNAP was directed at improving asthma control in the community by promoting preventive treatment with inhaled corticosteroids. This paper describes the program on prescription patterns of preventor and reliever medication for asthma in the polyclinics.
  
  
  METHODS
  We monitored the prescription pattern for asthma as the preventor-reliever (PR) drug ratio. The PR ratio was employed both as a positive feedback tool and as a key performance indicator (KPI) for the program. Individual clinics were encouraged to implement locally relevant and effective initiatives to increase the KPI and facilitate this process. The different methods included chronic care models, multidisciplinary teams, enhanced primary care clinics, pre-counselling screening, decision support tools, self-management support, a patient information system and community education.
  
  
  RESULTS
  In the course of the program, the case load for asthma in the polyclinics increased by 31%. During the same period, the average PR ratio increased significantly from 0.68 to 1.80 (P <0.001).
  
  
  CONCLUSIONS
  A simple audit and positive feedback program based on PR ratios, accompanied by sustained local quality improvement cycles has been associated with a significant shift in the drug treatment of asthma away from episodic quick relief medication towards long-term daily preventive treatment with inhaled steroids in polyclinics.
authors.affiliation: NHGP Asthma Committee, National Healthcare Group Polyclinics, Singapore.
authors.forename: Phui Nah
authors.initials: PN
authors.lastname: Chong
authors.forename: Ngiap Chuan
authors.initials: NC
authors.lastname: Tan
authors.forename: Tow Keang
authors.initials: TK
authors.lastname: Lim
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000554:Ambulatory Care Facilities; D001249:Asthma / Q000188:drug therapy* / Q000517:prevention & control; D011307:Drug Prescriptions; D005246:Feedback; D006801:Humans; D008485:Medical Audit; D015397:Program Evaluation; D012846:Singapore
chemical_list: D000305:Adrenal Cortex Hormones