Primary Care At-Risk Registry May Reduce Hospitalizations but Not Exacerbations in Patients with Severe Asthma
DynaMed Weekly Update - Volume 7, Issue 51
Guidelines for asthma management from the British Thoracic Society and Scottish Intercollegiate Guideline Network (PDF) suggest that primary care practices should maintain a registry of patients with asthma to facilitate management. A recent cluster randomized trial evaluated the efficacy of a patient registry system to reduce adverse outcomes in patients with severe asthma.
Twenty-nine primary care practices in England were randomized to a registry intervention vs. standard care for at-risk patients ≥ 5 years old with severe asthma. The registry intervention included the use of electronic alerts visible to all practice staff to indicate patient at-risk status, and staff training explaining the use of alerts and methods for improving both routine and emergency management of these patients. A total of 911 patients who were identified as at-risk for exacerbation based on British guideline criteria (presence of severe asthma plus at least 1 psychosocial indication that could hinder use of healthcare services and interventions) were enrolled in the trial and followed for 1 year.
In unadjusted analysis, the registry intervention was associated with a significant reduction in hospitalizations for asthma exacerbation (3.3% vs. 6.4% (p = 0.031, NNT 33). However, following adjustment for multiple factors, this difference was not quite statistically significant (p = 0.051) (level 2 [mid-level] evidence). Use of nebulized short-acting beta agonists was also lower in the intervention in unadjusted but not adjusted analyses (7.9% vs. 13.9%, p = 0.016, NNT 17, p = 0.061 in adjusted analysis). There was no significant difference in the incidence rate of moderate-to-severe exacerbations (53.6% vs. 46.5%), and the intervention was actually associated with a weak trend toward increased incidence (p = 0.105) in adjusted analysis. Overall costs were similar between the 2 groups (Thorax 2012 Dec;67(12):1052).
For more information, see the Asthma exacerbation in adults and adolescents topic in DynaMed.