Asthma costs and readmissions similar for primary, secondary care
medwireNews: There is a similar rate of readmission to hospital after an asthma attack regardless of the clinical setting in which patients are followed up, results of a Canadian study show.
There was also no difference in the direct costs of treatment, the researchers report in Chest.
"An ongoing question in chronic disease management is whether primary care provided by specialists is superior to the care provided by primary care physicians," say the study's investigators.
"In asthma, a significant economic and humanistic burden is generated by individuals with severe uncontrolled disease, especially those who require inpatient care," the researchers, from the University of British Columbia in Vancouver, add.
Mohsen Sadatsafavi et al used administrative data to look at the costs and health outcomes associated with 60 days' treatment in primary or secondary care after hospitalization for asthma. Follow up was for 1 year.
Data on a total of 2088 asthma patients treated in primary or secondary care were examined. Patients treated in secondary care were more likely to be male, were slightly older than those treated in primary care, and generally had a higher rate of asthma-related resource use.
The total direct cost of asthma treatment for the primary care group was approximately € 3470 (CAD$ 4510) and was € 3900 (CAD$ 5077) for the secondary care group. The difference in cost of approximately € 430 (CAD$ 567) was not statistically significant.
The rate ratio (RR) for readmission to hospital was 1.06, showing no benefit of being treated in secondary rather than in primary care in terms of this particular health outcome.
However, patients treated in secondary care were more likely to be referred to asthma-related outpatient services (RR=1.22) than patients treated in primary care. They were also more likely to receive treatment with an inhaled corticosteroid (ICS) plus long-acting beta-agonist (RR=1.43), as well as being less likely to be given an ICS alone (RR=0.92).
The proportion of days covered with a controlled medication was also significantly higher if patients had been treated in secondary rather than primary care (37.4 vs 34.3%).
"Compared with those who received only primary care, patients who received secondary care showed evidence of more appropriate treatment," Sadatsafavi and team write.
They note that the proportion of days covered with any controlled medication was poor in both groups, which could be influenced by a number of factors, including patient adherence.
"Addressing such issues as ensuring adherence, improving health literacy, and providing interventions targeted to particular patient groups might be the key factor in determining future outcomes," the researchers conclude.
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By Sara Freeman, medwireNews Reporter