Planned Health Care Non-Attendance and Asthma Control among Asthma Patients in Real Life Setting in an African Country: a Prospective Cohort Study

BACKGROUND: Compliance with scheduled medical visit is an indirect indicator of the adherence to treatment.The aim of this study was to determine the incidence of non-compliance with scheduled medical visits and investigate the predictors and relationship with disease control among patient with asthma in the sub-Saharan African setting. METHODS: We conducted a prospective study between January 2012 and August 2013. All patients with asthma receiving care at the Yaounde Jamot Hospital and CEDIMER medical practice were included. Planned medical visit occurred at month one; three; six and twelve following baseline evaluation. Regression models were employed to investigate the predictors of non-compliance. RESULTS: 186 patients [121 (65.1%) being female] were included. Their median age (25th-75th percentiles) was 35.5 (20.0-52.3) years. A total of 67 (36%) failed to attend at least one of the scheduled visits. The proportion of patients who failed to comply with scheduled visits was 48.4%; 68.8%; 73.5% and 79.5% at month one; three; six and twelve respectively. The accompanying rates of unacceptable asthma control were 17.2%; 24.4% and 20.8% respectively at three; six and twelve months of follow-up. Inadequate asthma control at baseline was the main predictor of non-compliance with medical visits; with adjusted odds ratio ranging from 2.00 to 4.67. Furthermore; non-sensitisation to non-pollinic aeroallergens was associated with 2.79 (95%CI 1.58-6.07) risk of non-compliance at one month of follow-up. CONCLUSION: Targeting education of patients with poorly controlled disease at baseline can potentially improve adherence to medical visit and anti-asthmatic treatments and outcomes of care

Asthma Control in Cities of Developing Countries: Results of a Five-City Survey

N/A

The Asthma Control Test and its Relationship with Lung Function Parameters

The Asthma Control Test (ACT) is a validated, simple,and inexpensive instrument to assess control among patients with bronchial asthma. However, its relationship with lung function parameters is yet to be demonstrated among Nigerian asthma patients. Our study aimed at assessing asthma control using ACT scores and determining its relationship with lung function parameters among persons with asthma in a university respiratory clinic.The cross-sectional study included 65 patients with bronchial asthma who underwent routine check-ups in respiratory clinics at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria between October 2009 and January 2011. The ACT was administered to assess for asthma control. Lung function testing was done using the guidelines of the American Thoracic Society (ATS).The mean pre-bronchodilator FEV1 (forced expiratory volume in 1 second) was 1.97±0.87L and mean ACT score was 18.2+4.28; 24 (37%) of the study subjects had well-controlled asthma. The ACT scores were weakly correlated with percentage of predicted,FEV1(r=0.220, p=<0.078) and PEF (peak expiratoryflow), (r=0.168,p=0.18).In this study, most of the patients had poor asthma control and lung function parameters correlated poorly with ACT scores. It is important that the ACT complements other physiological measures of assessing asthma control in our environment

Asthma Control Limitations in Selected Primary Health Care Clinics

Primary health care services worldwide are currently experiencing many quality-related problems. Efforts to improve these services appear to be sporadic and unsatisfactory. Investigations have revealed (Sharma et Sharma 2007) that one of the main causes for this state of affairs can be identif ed as neglected or inadequate documentation of patient/case history. The health care provider (HCP) should be equipped to improve the quality of health care and to take the lead in assuaging the predicament. The present study was undertaken to assess the correlation between asthma control and patient-related case history notes as recorded via the HCP. The data were obtained retrospectively from the patient notes of all asthmatic patients (including children and pregnant women) who attended six selected clinics in the North West Province of South Africa (Dr Kenneth Kaunda Municipal District). The analysis of the data collected from the patient clinic books confirmed the suspicion of poor quality of documentation; although the documentation in certain categories rendered some positive results. When compared to the GINAr guidelines; none of the patients had been controlled properly and only a small number (18.4) had been controlled partly (GINA 2008). Asthma control may be enhanced when a standard template is developed for completion by the HCP. It is envisaged that this will ensure that vital information regarding asthma control is documented in order to contribute to satisfactory chronic disease control