Quality of asthma care: Western Cape province, South Africa.
BACKGROUND
Asthma is the eighth leading contributor to the burden of disease in South Africa, but has received less attention than other chronic diseases. The Asthma Guidelines Implementation Project (AGIP) was established to improve the impact of the South African guidelines for chronic asthma in adults and adolescents in the Western Cape. One strategy was an audit tool to assist with assessing and improving the quality of care.


METHODS
The audit of asthma care targeted all primary care facilities that managed adult patients with chronic asthma within all six districts of the Western Cape province. The usual steps in the quality improvement cycle were followed.


RESULTS
Data were obtained from 957 patients from 46 primary care facilities. Only 80% of patients had a consistent diagnosis of asthma, 11.5% of visits assessed control and 23.2% recorded a peak expiratory flow (PEF), 14% of patients had their inhaler technique assessed and 11.2% were given a self-management plan; 81% of medication was in stock, and the controller/reliever dispensing ratio was 0.6. Only 31.5% of patients were well controlled, 16.3% of all visits were for exacerbations, and 17.6% of all patients had been hospitalised in the previous year.


CONCLUSIONS
The availability of medication and prescription of inhaled steroids is reasonable, yet control is poor. Health workers do not adequately distinguish asthma from chronic obstructive pulmonary disease, do not assess control by questions or PEF, do not adequately demonstrate or assess the inhaler technique, and have no systematic approach to or resources for patient education. Ten recommendations are made to improve asthma care.
Mash
Bob
B
Division of Family Medicine and Primary Care, Stellenbosch University, Tygerberg, W Cape. rm@sun.ac.za
Rhode
Hilary
H
Pather
Michael
M
Ainslie
Gillian
G
Irusen
Elvis
E
Bheekie
Angeni
A
Mayers
Pat
P
D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000453:epidemiology / Q000628:therapy*; D005081:Exercise Therapy / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011785:Quality Assurance, Health Care; D019035:Rural Health Services / Q000592:standards*; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
D018927:Anti-Asthmatic Agents