A retrospective chart review of the standard of asthma care in a primary care teaching clinic

Purpose: There is a national need to evaluate the current standard of practice in asthma.  This project works to measured uniformity of practice, identify gaps in follow up and measure hospitalization rate for asthma exacerbations within a primary care teaching clinic.

Methods: The project was completed by chart review of patients  (n=231) who received primary care at Smiley’s Clinic.  Inclusion criteria were as follows: seen in the past five years, have a diagnosis of ‘asthma’, have presented to clinic in the past two years, and were between the ages 5 and 50. Patients with a diagnosis of reactive airway disease were excluded.

Results: In the electronic medical record 54.2% (n= 125) of patients had a level of severity of asthma documented in the problem list (i.e., Moderate Persistent Asthma) whereas, 45.8% (n=106) of patients had “Asthma” as the diagnosis in the problem list. The average number of clinic visits per patient 2010-11 increased with increased severity of asthma and was highest for patients without a known severity of asthma control. Twenty-nine percent (n=67) of patients are exposed to tobacco smoke by secondhand smoke or active use. Twenty-four percent (n=54) of patients did not have a new prescription for an albuterol inhaler in 2010 or 2011.

Conclusion: There was lack of uniformity in the prescribing of albuterol inhalers, spirometry and disease documentation within this practice.  The lack of detail in asthma diagnosis within the problem list was related to increased patient hospitalization and increased albuterol inhaler prescriptions, which may serve as a marker for the need for increased attention to asthma management.