Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized Controlled Trial

Barbara P. Yawn; Peter C. Wollan; Matthew A. Rank; Susan L. Bertram; Young Juhn; Wilson Pace

doi:10.1370/afm.2179

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Author response: Future pragmatic trials
Barbara P Yawn

Published on: 21 March 2018
You can't manage what you don't measure...
David L. Hahn

Published on: 19 March 2018

Published on: (21 March 2018)

Author response: Future pragmatic trials
Barbara P Yawn, Adjunct Professor
Thank you Dr. Hahn for your comments on our study of the Asthma APGAR. We agree that broader inclusion criteria would be appropriate in the next study and appreciate the support that was given for all pragmatic trials in primary care.
I respect Dr. Hahn's stated preference for the ACT, however, it is not clear that Dr. Hahn has ever had the opportunity to use the Asthma APGAR in practice or teaching. The fac...
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Thank you Dr. Hahn for your comments on our study of the Asthma APGAR. We agree that broader inclusion criteria would be appropriate in the next study and appreciate the support that was given for all pragmatic trials in primary care.
I respect Dr. Hahn's stated preference for the ACT, however, it is not clear that Dr. Hahn has ever had the opportunity to use the Asthma APGAR in practice or teaching. The fact that the ACT has been used previously and may become a quality metric is well known by most of us. However, the patient outcomes as a result of use of the ACT in primary care practice are less clear. Certainly, a comparative effectiveness trial of the ACT and the Asthma APGAR tools in primary care would be a welcome step. The additional support provided by the Asthma APGAR tools may be of greater benefit to primary care physicians who are less experienced and with less asthma management expertise than Dr. Hahn is known to have. The studies of implementation of the asthma guidelines and asthma management suggest that many primary care physicians and other clinicians(1,2,3)may need more than simply a control score number to determine next steps in care and that is exactly why the Asthma APGAR was developed.
My hope is that instead of just continuing to do what has been done, results actually assessing the impact of the ACT on practice outcomes can be compared to the results of our study. And like Dr. Hahn, I hope more pragmatic primary care trials continue to be reported.
References:
1.Yawn BP, Rank MA, Cabana MD, Wollan PC, Juhn YJ. Adherence to asthma guidelines in children, tweens and adults in primary care settings: A practice-based network assessment. Mayo Clin Proc. 2016;91(4):411-421.
2. Brown M, Phillips CB, Ciszek K, et al. Children in the ACT with asthma--are they taking preventer medications according to guidelines? Aust Fam Physician. 2010;39(3):145-149.
3. Podjasek JC, Rank MA. Have expert guidelines made a difference in asthma outcomes? Curr Opin Allergy Clin Immunol. 2013;13(3):237-243.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (19 March 2018)

You can't manage what you don't measure...
David L. Hahn, Director
Kudos to Yawn et al. for performing a practice-based trial of a brief systematic asthma assessment tool (Asthma APGAR). More such studies are needed to inform the management of asthma in primary care. Hopefully such studies will be even more pragmatic than this one, that used two notorious efficacy exclusions: age over 45 and co-existence of an element of fixed obstruction, neither of which is justified in a truly pragmati...
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Kudos to Yawn et al. for performing a practice-based trial of a brief systematic asthma assessment tool (Asthma APGAR). More such studies are needed to inform the management of asthma in primary care. Hopefully such studies will be even more pragmatic than this one, that used two notorious efficacy exclusions: age over 45 and co-existence of an element of fixed obstruction, neither of which is justified in a truly pragmatic primary care study. Nevertheless, the results are encouraging and should be replicated in other settings.
Personally I prefer the Asthma Control Test (ACT) rather than the APGAR when evaluating asthma. I am aware that several large health systems are gearing up to integrate the ACT into the electronic medical record (EMR) in anticipation of the ACT being declared a "quality metric." It would be interesting to see the results of a comparative effectiveness trial using these two measurement modalities to manage asthma....using broad eligibility criteria that include ALL our asthma patients, not just those included in efficacy research.
Competing interests: None declared
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Competing Interests: None declared.