THE MANAGEMENT OF ASTHMA PATIENTS IN VARIOUS OUTPATIENT SETTINGS AT WINTHROP-UNIVERSITY HOSPITAL, MINEOLA, NEW YORK

Abstract

PURPOSE: We evaluated characteristics of asthma care and documentation by pediatricians (P), pediatric pulmonologists (PP), adult pulmonologists (AP) and allergists (A) at an academic medical center.
METHODS: Practice habits and documentation was extracted from 120 charts randomly chosen from each practice. 4 charts were dropped from pediatrics <6 years of age (too young for objective testing). Pediatrics n= 26; Allergy n=30; Adult pulmonary n=30; Pediatric Pulmonary n=30; Total n= 116.
RESULTS: Use of controller medications (inhaled steroids & or leukotriene inhibitors) was documented in 73% of (P), 87% of (A); 93% of (AP) and 93% (PP). For those patients whose asthma was classified (n=62) there was an increasing trend to use inhaled steroids as asthma severity increased (p<0.001). Objective testing: *Peak flow use varied between practices. 0% of (PP) patients compared to 97% of (A) patients. *Spirometry testing was mostly performed by (AP) 97% and 100% of (PP) patients. *Full PFT's: 0% of (P); 86% of (A); 27% of (AP) and 24% of (PP) patients had them (p<.0001). Pediatricians do the least amount of asthma office testing, but they referred the most (92%). *Asthma action plans were rarely documented (13%) of (PP) charts (p<0.004).
CONCLUSION: The delivery and documentation of patient care varies greatly by practice. *Pediatricians tended to use less controller medications. Allergists used the least amount of leukotriene inhibitors. *All practices documented increasing use of inhaled steroids based on the severity of asthma. Despite the widespread requirement to classify asthma according to the NHLBI guidelines, this is rarely performed and documented in the practice settings of allergists or pulmonary specialists.* Hardly anyone uses asthma action plans.
CLINICAL IMPLICATIONS: Many agencies require the use of classifying asthma severity according to the guidelines, using peak flows and formulating asthma action plans. However,it was not documented with any consistency in the practices reviewed.
DISCLOSURE: Grace Trimmer, None.