Dorothy Pardalis, BSc.Phm. C.A.E.

Proactive Health Strategies Inc.

Essex County Community Asthma Care Strategy

“A proactive community response to a global healthcare challenge”

Cost of Asthma in Ontario

 Annual cost $2,550 / annum (1995)  ($1,255 to $5,032) 

Direct costs 50.2%

 Physician visits, Lab, Hospitalization, Prescriptions  Hospitalization and medication each 22% 

Indirect costs 49.8%

 Absence from work or usual activity  Travel and waiting time  Ungar WJ Can. Resp. Journal 1998;5:463-471

Cost of Asthma in Ontario

6000 5000 4000 3000 2000 1000 0 Young, Mild, Non Smoker Older, Severe Smoker Annual Cost

Asthma

2 million or 8.4% of Canadians

Asthma Control

Parameter Frequency or Value

      Daytime symptoms Nighttime symptoms Physical activity Exacerbations Absence from work or school Need for short-acting B 2 -agonist      < 4 days/week < 1 night/week Normal Mild, infrequent None  < 4 doses/week*

Canadian Asthma Consensus Report, 1999; 2001 and 2003 Updates

*excluding one dose/day to prevent exercise-induced symptoms

Health Status of Asthma Patients Canada Windsor Essex

    28% visited the ER 7% were hospitalized 43% MD visit 50% visited the ER, was hospitalized, or received other emergency care  20% missed school or work in the prior year  >70% were not achieving benchmark control  Asthma in Canada 2000 - A Landmark Survey     21% visited the ER 5% were hospitalized 53% MD visit 50% visited the ER, was hospitalized, or received other emergency care  33% missed school or work in the prior year (8.99 days)  60% were not achieving benchmark control  Current ECCACS statistics n=672

Preliminary Results Utilization Year Prior to Intervention 60 50 40 30 20 10 0 Family MD Walk-In Specialist % Requiring Visit for Symptoms ER Hospitalized

Preliminary Results Absenteeism

 Absent from school or work in the past 12 months  33% of participants  Average number of days missed  8.99 Days

Health Status of Asthma Patients



SYMPTOMS > 4 TIMES WEEKLY IN THE PREVIOUS MONTH

 Cough :

46 %

     Wheeze : Shortness of Breath: Chest Tightness: Nocturnal Cough:

17 % 21 % 14 % 29 %

Use of Rescue Medicine :

19 %

Current ECCACS statistics n=672

Preliminary Results Baseline Symptom Control 60 50 40 30 20 10 0 C ou gh Wh ee ze SO B C he st T igh t N oc tu rn al R esc ue M N ot ed in C on tr ol Percentage out of Benchmark

Program Model

 Individualized education – Primary Care  Initial assessment, follow-up at 1-3 months  Electronic software tool that standardizes the intervention  Self-management education  Effective chronic disease management requires active participation of the patient  Interdisciplinary care  Objective testing: lung function

Patient Identification

 Primary Care  Look-back program  Emergency Departments  Walk-in Clinics  Employers

Self-management Skills

 General knowledge of asthma  Understanding of triggers / avoidance  Understanding role of medication in control  Recognition of symptoms / control  Self-monitoring of symptoms / peak flow  Device skills for inhaled medication  Understanding and confidence to enact set of recommendations to adjust medication

Asthma Self Management Action Plan

Target Numbers

 1,500 patient encounters  390 days of engagement

Outcome Analysis

 Primary: Improve asthma symptom control three months post-intervention  Secondary:  Reduced healthcare utilization  Reduced asthma exacerbations  Reduced absenteeism  Improved lung function

Supporting Organizations

 Asthma Research Group  Essex County Pharmacists Association  Hotel-Dieu Grace Hospital   University of Windsor St. Joseph’s Health Care London  Leamington District Memorial Hospital  DaimlerChrysler

Preliminary Data: Patient Satisfaction (n=310) 100 80 60 40 20 0 In te ra ct io n E du ca to r R es pe ct P ri va cy Q ua lit y E du ca ti on Q ue st io ns A ns w er ed Very Satisfied Satisified Neutral O ve ra ll A bi lit y Se lf M an Unsatisfied

More data to come …

Dorothy Pardalis [email protected]