Outcome of Easy asthma clinic Prasat hospital, Surin province

Abstract

Background: Asthma is common chronic disease and acute asthmatic attack is one of leading cause of emergency room visit and hospitalization. According to survey, it revealed that the asthma treatment in Thailand was poorly managed. In Prasat hospital, a majority of patients visiting outpatient clinic can not control disease while the cost burden of asthma treatment is high, ranging as one of top ten hospital spending for outpatient diseases. From the above rationale, Prasat Hospital therefore, founded Easy Asthma clinic based on the asthma management guideline issued by the department of medicine, Khonkean university in February 2008 by applying the standard GINA guideline 2006 for total asthma control goal .
Objective:
1. Analyse a level of asthma controlled in patients attending Easy asthma clinic in Prasat hospital
2. Compare a level of asthma controlled of population pre- and post-registration into Easy asthma clinic.
3. Compare a frequency of emergency room visit and hospitalization due to acute asthmatic attack pre- and post-establishment of Easy asthma clinic.
4. Analyse a cost of Inhaled corticosteroids(ICS : Budesonide) and Inhaled corticosteroids/Long acting Beta2 agonist (ICS/LABA: Salmeterol /Fluticasone) pre- and post-establishment of Easy asthma clinic as well as compare a cost reduction due to decreased rate of emergency room visit and hospitalization due to acute asthmatic attack with a cost increment from ICS and ICS/LABA use post-establishment of easy asthma clinic.
Setting design: Retrospective study
Methods: The target population is asthmatic patients aged >15 years old who attended the asthma clinic for at least six consecutive months. 98 patients were included in this research. Research tool includes asthma clinic medical records which contained the level of asthma controlled in patients attending Easy asthma clinic from 1 February 2008 to 30 June 2009. The information regarding the frequency of emergency room visit, hospitalization due to acute asthmatic attack and cost of ICS and ICS/LABA were collected from Mit-net and HosXp hospital’s computer program during a period of 17 months covering pre- and post Easy asthma clinic establishment (1 September 2006 - 31 January 2008 and 1 February 2008 -30 June 2009). Descriptive statistics was performed and reported in term of percent, mean and standard deviation. Analytical statistics was also performed using Chi-square and Paired t -test methods.
Research Result: The treatment outcome measured by a level of asthma controlled at 1 year post- registration into easy asthma clinic showed that 46.20 % of patients achieved partly controlled while 40 % of patients population can achieve the total controlled. The comparison of a level of asthma controlled was done at 4 time points i.e., at the registration into this clinic, 3 month, 6 month and 1 year following registration of Easy asthma clinic showed statistically significant improvement of a level of asthma controlled. All of patients using ICS or ICS/LABA as disease controller. Furthermore, the establishment of Easy asthma clinic can also contribute to the decreased frequency of emergency room visit with statistically significance while the frequency of hospitalization due to acute asthmatic attack may also decrease. However, the cost increment from the use of ICS or ICS/LABA has exceeded the saved cost gained from a reduce frequency of emergency room visit and hospitalization.
Conclusion: This research indicates that implementation of Easy Asthma clinic in a community hospital allows asthmatic patients to access a standard treatment and improve better disease control outcome.