Sunday, May 8, 2011

Asthma Rates Are Going Up. Time to Think About Other Approaches to Care

Peak Flow Meter
According to the CDC's Morbidity and Mortality Report (MMWR), the prevalence of asthma in the United States has increased from 7.3% (20.3 million persons) in 2001 to 8.2% (24.6 million persons) in 2009.  Just over half of these individuals (52.6%) have had at least one asthma attack, and of these, 42% (or 4.6 million) have lost a day of school or work in the course of a year.  Of all persons with asthma, only 42% have been taught to use a peak flow meter and only 34% have an action plan.

This is important because widely accepted asthma treatment guidelines recommend that a peak flow meter be made available to patients with asthma so that they can detect subtle changes in air flow which could herald an asthma attack.  In addition, a written asthma "action plan" should be prepared so that patients with asthma know what to do if their symptoms spiral out of control.  Those are two key interventions that could significantly reduce the huge number of school and work days lost described above.

Unsurprisingly, the MMWR report ignores all that and ends with a bland call for programs that "empower" persons with asthma, address gaps in access to care, support preventive measures, promote self-management education and expand reimbursement for asthma education.

That may sound good, but it ain't happening.  It doesn't take an epidemiologist to conclude that there is absolutely no chance that the current one-on-one health care system is going to educate more than 10 million persons with asthma about peak flow meters or action plans.  There are not enough physicians, physician assistants, nurse practitioners, appointments, office visit minutes, patient centered medical homes or integrated delivery systems to handle it all.

Given the rising rates of asthma, what other options are out there?  Maybe it's time to get serious about virtual clinics, turbo-charged community based organizations, remote telephonic coaching including cellphones as well as web-based interactions with monitoring. School budgets are being cut back, but asthma may be a reason to keep school nurses around as an option for children and adolescents.  Perhaps lay people can be asthma educators.  Social media such as Twitter may also be able to play a role.

The good news is that the population health and disease management industry, in partnership with insurers, primary care, the medical home community and employers, is already working on these and other new approaches to caring for asthma.  As experience with them grows, the DMCB is looking forward to reading about their positive outcomes.  They'll not only be reported on this blog, but who knows... maybe they'll even be a topic of a future edition of MMWR.

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