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J Asthma. 2019 Jan 18:1-12. doi: 10.1080/02770903.2018.1554069. [Epub ahead of print]

Documentation of asthma control and severity in pediatrics: analysis of national office-based visits.

Author information

1
a Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy , University of Houston , TX , USA.
2
b US Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
3
c US Clinical Development and Medical Affairs, Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
4
d Northshore University HealthSystem , Evanston , IL , USA.
5
e Department of Pediatrics , University of California , San Francisco , CA , USA.
6
f Department of Epidemiology and Biostatistics , University of California , San Francisco , CA , USA.
7
g Philip R. Lee Institute for Health Policy Studies , University of California , San Francisco , CA , USA.
8
h Boys Town National Research Hospital , Boys Town , NE , USA.

Abstract

OBJECTIVE:

To evaluate the extent of documentation of asthma control and severity and associated characteristics among pediatric asthma patients in office-based settings.

METHODS:

This cross-sectional study utilized data from the 2012-2015 National Ambulatory Medical Care Survey (NAMCS). Patients aged 6-17 years with a diagnosis of asthma were included. Weighted descriptive analysis examined the extent of documentation and uncontrolled asthma; while logistic regression evaluated associated characteristics.

RESULTS:

Overall, there were 2.47 million (95% confidence interval, 95% CI: 2.04-2.90) average annual visits with asthma as a primary diagnosis. Asthma control and severity was documented in only 36.1% and 33.8% of the visits, respectively. An established patient (odds ratio, OR = 3.81), Hispanic ethnicity (OR = 2.10), chronic sinusitis (OR = 5.59), and visits in the Northeast (OR = 2.12) and Midwest (OR = 2.25) regions had higher odds of documented asthma control status, whereas undocumented asthma severity (OR = 0.02), and visits in spring (OR = 0.34), had lower odds. Osteopathic doctors (OR = 0.18), visits in the Northeast region (OR = 0.23), chronic sinusitis (OR = 0.08), and undocumented asthma control status (OR = 0.03) had lower odds of documented asthma severity, whereas visits in spring (OR = 3.88) and autumn (OR = 3.32) had higher odds. Moderate/severe persistent asthma (OR = 15.35) had higher odds of uncontrolled asthma (as compared to intermittent asthma), while visits in the summer (OR = 0.14) had lower odds.

CONCLUSION:

The findings of this study suggest a critical need to increase the documentation of asthma severity and control to improve quality of asthma care in children.

KEYWORDS:

Asthma; asthma control; asthma severity; documentation; pediatric; uncontrolled asthma

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