Article Figures & Data
Figures
- Figure 1
Asthma APGAR patient form.
- Figure 2
CONSORT diagram for cluster-randomized trial of APGAR tools implementation in primary care.
APGAR = Activities, Persistent, triGGers, Asthma medications, Response to therapy; CONSORT = Consolidated Standards Of Reporting Trials.
- Figure 3
Primary outcomes: asthma-related ED, urgent care, and hospital visits, and asthma control (rates of “in control”).
ACT = Asthma Control Test; APGAR = Activities, Persistent, triGGers, Asthma medications, Response to therapy; ED = emergency department.
a ACT score ≥20.
Note: Rates of asthma-related ED, urgent care, and hospital visits compared with χ2 test. Rates of asthma control compared with McNemar test.
Tables
Characteristic APGAR Tools Group (n=496) Usual Care Group (n=157) Transition Group (n=190) Difference P Value Age, mean, y 29.1 28.7 26.6 – Race/ethnicity, % .001 White 86.7 79.6 80.6 Black 8.9 16.6 14.1 Other/none 5.2 3.8 5.3 Hispanica 7.0 6.3 23.0 Annual family income, % – <$10,000 13.7 19.7 17.4 $10,000 to $49,999 33.1 34.4 45.3 ≥$50,000 50.2 43.9 34.2 Not reported 3.0 2.0 3.1 Body mass index, obese, % 40.0 34.1 38.9 – Secondhand smoke exposure, % – Ever 5–7 d/wk 47.0 55.4 42.1 Now 5–7 d/wk 19.4 20.4 16.8 Smoking, % – Current 10.3 7.6 7.4 Ever 26.0 20.4 16.8 Activity level: strenuous activity, % – ≥3 times/wk, 15 min 40.1 37.6 35.3 ≥5 times/wk, 15 min 20.6 17.8 17.9 Allergy tests ever, yes, % 51.2 53.5 48.9 – Asthma not in control: ACT scoreb <20, % 59.2 57.4 56.8 – Thought they needed asthma care and could not get it, % 14.3 14.6 20.6 – Asthma-related visit to ED, urgent care, or hospital in 6 mo before enrollment, % 17.5 15.9 22.1 – Age-group, % – Child (5–11 y) 21.7 18.8 30.5 Adolescent (12–18 y) 15.8 20.2 14.2 Adult (>18 y) 62.5 61.1 55.3 ACT = Asthma Control Test; APGAR = Activities, Persistent, triGGers, Asthma medications, Response to therapy; ED=emergency department.
↵a Only significant difference was proportion Hispanic.
↵b Possible range is 5 to 25; higher scores indicate poorer control.
Note: Analyses based on data from 843 patients (the 79.1% of enrolled patients who returned baseline questionnaires).
- Table 2
Barriers to and Facilitators of Practice Implementation of APGAR Tools Captured by Staff Comments
Measure Staff Comments Barriers Time “It takes time to try something new—we don’t have time.” Limited physician buy-in “Some physicians are just not willing to try anything new.” Limited nursing staff acceptance Lack of centralized mandate “Some of the nursing staff only do what is required by their physicians.” Unsure of need “Our patients are doing OK.” Facilitators Feedback from patients “[With the Asthma APGAR tools] we actually knew what the patient was doing and thinking.” Asthma as quality target for practice Case reports “I got more information than I have ever had and…. it improved care.” Ease of use of tools Tools developed in primary care “Using the system definitely improved the asthma care and the patients liked it.” APGAR = Activities, Persistent, triGGers, Asthma medications, Response to therapy.
Supplemental Appendixes
Supplemental figures 1-4 and supplemental tables 1-4
Files in this Data Supplement:
- Supplemental data: Appendixes - PDF file
The Article in Brief
Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized Controlled Trial
Barbara P. Yawn , and colleagues
Background Implementation of asthma guidelines is challenging and the burden of the condition remains high. This study tests the effects of Asthma APGAR tools, including an asthma control assessment completed by patients and linked to an asthma management algorithm, on patient outcomes and practices� adherence to asthma guidelines.
What This Study Found The Asthma APGAR tools help decrease asthma-related visits to the emergency department, urgent care or hospital and improve patients� asthma control. A randomized controlled study of 18 family medicine and pediatric practices across the United States compared outcomes in more than 1,000 patients with persistent asthma aged five to 45 years using Asthma APGAR tools versus usual care. The proportion of patients reporting an asthma-related emergency department, urgent care or hospital visit in the final six months of the study differed significantly between groups: 11 percent for intervention groups and 21 percent for usual care groups. Between baseline and one year, the percentage of patients whose asthma was in control increased significantly in the intervention group (14 percent) compared to the usual care group (3 percent), with a trend toward better control scores and asthma-related quality of life in the intervention group at 12 months. Intervention practices also significantly increased their adherence to three or more elements of the National Asthma Education and Prevention Program guidelines compared to usual care practices. Participating practices reported that changing practice to incorporate the Asthma APGAR tools was challenging, but the tools themselves were perceived as useful and efficient.
Implications
- The authors suggest that the Asthma APGAR tools are effective for asthma management in the primary care practice setting.
