Asthma Education and Severity Control on the Decline, With Primary Care Providers Undertaking Nearly Two-Thirds of Asthma-Related Visits

Adherence to documenting asthma severity or control and providing ample education to patients was low among physicians from 2012-2015, with primary care providers monitoring nearly two-thirds of asthma-related visits, according to a national health statistics report published last week by the CDC.

A report on national estimates of asthma visits to physician offices was last released in 1996, utilizing data from the National Ambulatory Medical Care Survey (NAMCS) to determine physician familiarity with, and use of, the 1991 National Asthma Education and Prevention Program (NAEPP) guidelines. The report assessed asthma visits to non-federally employed U.S. physicians from 2001 to 2016, asthma visit characteristics from 2012 to 2015, and consistency of visit characteristics with NAEPP guidelines.

Asthma affects 8.3% of Americans with an attributed 1.8 million emergency room visits in 2016. Its episodic symptoms can become life-threatening, which heightens the need to monitor symptoms for preventative care. As most asthma management and patient education occurs in primary care settings, it is vital for physicians to utilize this space to ensure patients are aware of the severity of their condition.

Researchers utilized data from visits, as well as, NAMCS data from 2012-2015 and a supplement of 2012 National Asthma Survey of Physicians (NAS) data for the study.

Results showcased a stark decline in asthma visit rates from 2001 to 2016 (40.2 to 30.7 per 1000 persons) and at-risk visit rates (55.5 to 36.7 visits per 100 persons with asthma). From 2012 to 2015, there was an annual average of 10.2 million asthma visits in which 63.5% were by non-Hispanic white persons, 53.8% by female patients, and 32.5% by children under the age of 15. Population and at-risk visit rates were similar in sex, racial, and ethnic groups, with children aged 4 and younger found to have the highest at-risk asthma visit rate.

Of physicians undertaking asthma visits, 60% were handled by primary care physicians. Across the study, documentation and education of asthma were relatively low:

• Asthma severity documented in 34.5% of visits, asthma control in 40.9%, spirometry in 14.9%, and peak flow in 3.3%
• Asthma education provided in 21.4% of asthma visits and asthma action plans in 9.9%

Researchers additionally found that bronchodilators were the most commonly mentioned medical class (24.9%), and albuterol, which is a quick-acting relief medication, was the most frequently mentioned treatment (16.9%).

Lead study author Lara Akinbami, MD, medical officer for the infant, children, and women’s health statistics branch of the office of analysis and epidemiology at the National Center for Health Statistics (NCHS), spoke in a NCHS blog about the study’s findings. “Given its high burden in morbidity, health care use, and mortality, it is important to assess the content of asthma physician office visits given that physicians are on the “front line” of asthma care and provide the majority of asthma care,” said Akinbami.

Akinbami noted that her biggest surprise in the data was that 59.1% of asthma patients had no level of control documented by physicians, especially when considering the efforts taken to have asthma controlled, assessed, and documented through NAEPP guidelines. “Additional research can explore the underlying reasons for trends, and future policy can target low implementation rates of guideline recommendations,” said Akinbami.

Reference

Akinbami LJ, Santo L, Williams S, et al. Characteristics of asthma visits to physician offices in the United States: 2012—2015 National Ambulatory Medical Care Survey. National Health Statistics Reports; no 128. Hyattsville, MD: National Center for Health Statistics. [published online September 20, 2019].