URBAN & RURAL DIFFERENCES IN THE MANAGEMENT OF ASTHMA AMONGST PRIMARY CARE PHYSICIANS IN ALBERTA
Main Article Content
Keywords
Asthma, community health, primary medicine, rural medicine
Abstract
Background
Inconsistencies in rural and urban health care exist; however, little has been done to evaluate the potential differences in asthma management.
Objective
To compare asthma management in rural versus urban primary care physician practices.
Methods
Forty-two of 136 consenting primary care physicians were randomly selected for chart review. The charts of 3072 patients diagnosed with asthma based on the ICD-9 Classification of Diseases were reviewed.
Results
Standards of asthma care were compared between rural and urban primary care physicians. 2671 patients (87%) were cared for by urban physicians and 401 patients (13%) by rural physicians. Greater proportions of male and pediatric patients were found in the rural group. Rural patients made more emergency department or hospital visits than urban patients. Rural physicians performed more pulmonary function tests and made more referrals to other healthcare specialists. Urban patients had more asthma symptoms and triggers documented and used peak flow monitoring more often. Urban physicians provided more asthma education and prescribed more oral corticosteroids and antibiotics. Overall, rates of referral, use of spirometry and use of written action plans were low globally.
Conclusions
Our study indicates that the management of asthma in the rural settings is comparable to that of urban
settings. Improvements in the areas of pulmonary function testing, asthma education and use of written action plans are necessary in both settings.
References
2. Humphreys J, Hegney D, Lipscombe J, et al. Whither rural health? Reviewing a decade of progress in rural health. Aust J Rural Health 2002;10:2-14.
3. Pampalon R. Health discrepancies in rural areas in Quebec. Soc Sci Med 1991;33:355-360.
4. Watts RW. Asthma management in rural Australia. Aust J Rural Health 1999;7:249-252.
5. Yawn BP, Mainous AG, Love MM, et al. Do rural and urban children have comparable asthma care utilization? J Rural Health 2001; 17:32- 39.
6. Mitura V, Bollman RD. The health of rural Canadians: a rural- urban comparison of health indicators. Rural and Small Town Canada Analysis Bulletin 2003;4:1-23.
7. McIlwraith RD, Dyck KG. Strengthening rural health: the contribution of the science and practice of psychology. Ottawa, ON: Can Psychol Assocn 2002;1-9.
8. Society of Rural Physicians of Canada. The SRPC state of rural healthcare page. http://www.srpc.ca/librarydocs/Kirby_SRPC.ht m (February 12, 2005).
9. Beshiri R, Bollman RD. Population structure and change in predominantly rural regions. The Daily [serial online]. January 2001: Catalogue 21-006 XIE.http://www.statcan.ca/english/freepub/21-006- XIE/21-006- XIE00002.pdf (Accessed February 12, 2005).
10. Sorenson M, de Peteur J. Rural Alberta Profile: A Ten Year Census Analysis. Rural Research and Analysis Unit, Rural Secretariat, Agriculture and Agri-Food Canada 2005.
11. Ryan-Nicholls KD. Health and sustainability of rural communities. Rural and Remote Health [serial online] 2004; 4 (1). http://rrh.deakin.edu.au/articles/showarticlenew. asp?ArticleID=242 (Accessed February 12, 2005).
12. Kaiser Commission on Medicaid and the Uninsured. The uninsured in rural America. Key Facts [serial online]. April 2001. http://www.kff.org/uninsured/loader.cfm?url=/c ommonspot/security/getfile.cfm&PageID=1376 4 (Accessed February 12, 2005).
13. Statistics Canada. The Statistics Canada persons with asthma by age and sex page. http://www.statcan.ca/english/Pgdb/health49a.ht m (Accessed February 12, 2005).
14. The National Asthma Control Task Force. The Prevention and management of asthma in Canada: a major challenge now and in the future, 2000. Available at: http://www.phac- aspc.gc.ca/publicat/pma- pca00/pdf/asthma00e.pdf (February 12, 2005).
15. Statistics Canada. The Statistics Canada persons with asthma by sex, provinces page. http://www.statcan.ca/english/Pgdb/health50a.h t m (Accessed February 12, 2005).
16. Krahn MD, Berka C, Langlois P, et al. Direct and indirect costs of asthma in Canada, 1990. CMAJ 1996;154: 821 -831.
17. Canadian Asthma Consensus Group. Canadian asthma consensus report, 1999. CMAJ 1999;161(11Suppl):S1 -62.
18. Lemiere C, Bai T, Balter M, et al. Adult asthma consensus guidelines update 2003. Can Respir J 2004; Suppl A; 9A-18A.
19. Tsuyuki R, Sin D, Sharpe H, et al. Management of asthma among community- based primary care physicians. J Asthma 2005;42(3):163-7.
20. Sharpe H, Sin D, Andrews E, et al. Alberta Strategy to Help Manage Asthma (ASTHMA): A provincial initiative to improve outcomes for individuals with asthma. Healthcare Quarterly 2004;7:55-60.
21. Sin D, Man P, Cowie R, et al. Recruitment of network and non- network primary care physicians to participate in a provincial asthma study. Can Family Physician 2004;50:1251-4.
22. Du Plessis V, Beshiri R, Bollman RD, et al. Definitions of "Rural". Agriculture and Rural Working Paper Series 2002; Working Paper No. 61. Ottawa, On tario: Statistics Canada, Agricultural Division. http://www.statcan.ca/english/research/21-601- MIE/21 -601-MIE2002061.htm (Accessed February 12, 2005).
23. Toth EL, Majumdar SR, Guirguis LM, et al. Compliance with clinical practice guidelines for type 2 diabetes in rural patients: Treatment gaps and opportunities for improvement. Pharmacotherapy 2003;23(5):659-65.
24. Chapman KR, Ernst P, Grenville A, et al. Control of asthma in Canada: Failure to achieve guidelines targets. Can Respir J 2001;8 Suppl A:35A -40A.
25. Asthma in America. Asthma in America survey news release page. Available at: http://www.asthmainamerica.com/newsrelease.h tm (February 12, 2005).26. Cowie RL, Underwood MF, Sin DD, Sharpe HM, Bell NR, Man SFP. Asthma Control and Management in the Community: 1997 compared with 2002. Can Fam Physician 2006;52:750-51. http://www.cfpc.ca/cfp/2006/jun/vol52-jun-res- cowe.asp
27. FitzGerald JM, Boulet LP, McIvor RA, Zimmerman S, Chapman KR. Asthma control in Canada remains suboptimal: The Reality of Asthma Control (TRAC) study. Can Respir J 2006;13:253-9.
28. Barbanel D, Eldridge S, Griffiths C. Can a self- management programme delivered by a community pharmacist improve asthma control? A randomised trial. Thorax 2003;58:851-854.
29. Chan DS, Callahan CW, Sheets SJ, et al. An internet-based store- and-forward video home telehealth system for improving asthma outcomes in children. Am J Health Syst Pharm 2003;60(19):1976-1981.
30. Lozano P, Finkelstein JA, Carey VJ, et al. A multisite randomized trial of the effects of physical education and organization change in chronic asthma chronic-asthma care: health outcomes of the Pediatric Asthma Care Patient Outcomes Research Team II Study. Arch Pediatr Adolesc Med 2004;158(9):875-883.
31. Tong S, Drake P. Hospital admission and mortality differentials of asthma between urban and rural populations in New South Wales. Aust J Rural Health 1999;7:18-22.
32. Health Canada. Health Canada definitions of “rural” summary page. http://www.hc- sc.gc.ca/english/pdf/rural_health/Rural_Executiv e_Summary.pdf (Accessed February 12, 2005).
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.