Specialist care in individuals with asthma who required hospitalization: a retrospective population-based study
Kendzerska T, Aaron SD, Meteb M, Gershon AS, To T, Lougheed MD, Tavakoli H, Chen W, Kunkel E, Sadatsafavi M; Canadian Respiratory Research Network. J Allergy Clin Immunol Pract. 2021; 9(10):3686-96. Epub 2021 Jun 25. DOI: https://doi.org/10.1016/j.jaip.2021.06.018
Background — Patients who are at risk of severe asthma exacerbations should receive specialist care. However, the care pattern for such patients in the 'real world' is not clear.
Objectives — To describe the pattern of care among individuals with asthma who required hospitalization, and to identify factors associated with receiving asthma specialist care.
Methods — This was a retrospective population-based study using health administrative data from two Canadian provinces. Individuals aged 14 to 45 years who were newly diagnosed with asthma between 2006-2016 and had at least one hospitalization for asthma at or within five years following their initial asthma diagnosis were included. First, we calculated frequencies of primary and specialist care around asthma diagnosis: one year before and two years after in a 6-month period. Next, among individuals diagnosed with asthma by a primary care physician, we used multivariable Cox regressions to identify factors associated with receiving specialist care.
Results — For 1,862 individuals included, we found that most individuals (≥71% per time period) were cared for by their primary care physicians one year prior and two years after the asthma diagnosis; the percentage of individuals seen at least once by a specialist for asthma and/or asthma-related respiratory conditions during the first six months since the diagnosis did not exceed 40%. Among 1,411/1,862 (76%) individuals who were under primary care before the asthma diagnosis, controlling for covariates, living in a rural area or a low-income neighbourhood were associated with less likelihood of receiving specialist care.
Conclusions — Despite recommendations, more than half of individuals with asthma who required hospitalization did not receive specialist care during the first two years since the diagnosis. Identified factors associated with receiving asthma specialist care suggested access is an important barrier to receiving the recommended care.