Usefulness of the Asthma Control Test in a Continuity Clinic

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Title: Usefulness of the Asthma Control Test in a Continuity Clinic  

Authors: Rhea Basu, Margarita Dionysiou, Bayan M. Abdallah, Dafna Sudai, Andrew Paoletti, Kelly-Bradley Dodds

Background: Asthma is the most prevalent chronic disease of childhood and disproportionately affects African-American and Hispanic populations. Current guidelines recommend assessing asthma control at every primary care visit.  The Asthma Control Test is a validated tool to assess asthma control and potentially guide provider management. 

Objectives: To assess the impact of the Asthma Control Test (ACT) on provider practice in a continuity clinic.  

Design/Methods: We conducted a cross-sectional study of asthma encounters in a continuity clinic in a medical center that serves an urban low-income, minority population. The study population included a convenience sample of encounters of English speaking patients aged4+ years with a diagnosis of asthma who presented to the clinic between 01/01/2018 and 02/28/2019. We excluded children with a history of prematurity (<35 weeks gestation) and those recently placed in foster care. Outcome measures were documentation of asthma severity and control, medication management (refill or change in controller medication) and referral to subspecialist (Pulmonology or Allergy).

Results: The study population included 127 encounters of children with asthma: mean age 8 years, 75% African American, 43% female, 85% Medicaid. In 30% of the encounters providers used an ACT.  Providers that used an ACT were more likely to document asthma severity (92% ACT used vs. 84% ACT not used) and were also more likely to document asthma control (47% ACT used vs 31% ACT not used), but these differences were not statistically significant. The rates of medication refill and changes in medication and subspecialist referral were comparable among between encounters with and without ACT.  

Conclusions: The use of ACT was not associated with significant changes in provider documentation or management of asthma in a continuity clinic. Additional research is needed to evaluate the feasibility and usefulness of adopting the ACT in continuity clinics.

Einstein Medical Center Philadelphia
Einstein Medical Center Philadelphia

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