title: Costs and health outcomes associated with primary vs secondary care after an asthma-related hospitalization: a population-based study.
abstract: BACKGROUND
  Patients with a history of asthma-related hospitalizations are at high risk of readmission and generally consume a large amount of health-care resources. It is not clear if the secondary care provided by specialists after an episode of asthma-related hospitalization is associated with better outcomes compared with the primary care provided by general practitioners.
  
  
  METHODS
  Using population-based administrative health data from the province of British Columbia, Canada, we created a propensity-score-matched cohort of individuals who received primary vs secondary care in the 60 days after discharge from asthma-related hospitalization. Total direct asthma-related medical costs (primary outcome) and health service use and measures of medication adherence (secondary outcomes) were compared for the next 12 months.
  
  
  RESULTS
  Two thousand eighty-eight individuals were equally matched between the primary and secondary care groups. There was no difference in the direct asthma-related costs (difference $567; 95% CI, -$276 to $1,410) and rate of readmission (rate ratio [RR] = 1.06; 95% CI, 0.85-1.32) between the secondary and the primary care groups. Patients under secondary care had a higher rate of asthma-related outpatient service use (RR = 1.22; 95% CI, 1.11-1.35) but a lower rate of short-acting β-agonist dispensation (RR = 0.91; 95% CI, 0.85-0.98). The proportion of days covered with a controller medication was higher among the secondary care group (difference of 3.2%; 95% CI, 0.4%-6.0%).
  
  
  CONCLUSIONS
  Compared with those who received only primary care, patients who received secondary care showed evidence of more appropriate treatment. Nevertheless, there were no differences in the costs or the risk of readmission. Adherence to asthma medication in both groups was poor, indicating the need for raising the quality of care provided by generalists and specialists alike.
authors.affiliation: Institute for Heart and Lung Health, Faculty of Medicine, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, BC, Canada; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada. Electronic address: msafavi@mail.ubc.ca.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Sadatsafavi
authors.affiliation: Institute for Heart and Lung Health, Faculty of Medicine, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, BC, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: FitzGerald
authors.affiliation: Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, The University of British Columbia, Vancouver, BC, Canada.
authors.forename: Carlo
authors.initials: C
authors.lastname: Marra
authors.affiliation: Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, The University of British Columbia, Vancouver, BC, Canada.
authors.forename: Larry
authors.initials: L
authors.lastname: Lynd
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000191:economics* / Q000628:therapy*; D001955:British Columbia; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics*; D057216:Propensity Score; D063127:Secondary Health Care / Q000191:economics*; D016896:Treatment Outcome