ABSTRACT
Background: Addressing the challenges of asthma has involved various approaches, including the examination of costs associated with hospitalization. However, there is a limited number of studies that have investigated the actual expenses incurred by hospital settings in caring for asthma patients. This study aims to describe the costs, predictors, and breakdown of expenditures in different categories. Design and methods: A retrospective cohort study was conducted, involving 314 hospital stays of patients over 12 years old who were admitted for asthma and classified under APR-DRG 141 (asthma). Univariate and multiple linear regression analyses were performed. Results: The median cost, regardless of DRG severity, amounted to 2.314 (1.550-3.847). Significant variations were observed when the sample was stratified based on the severity of DRG, revealing a cost gradient that increases with severity. The length of stay followed a similar trend. Six predictors were identified: age, admission to intensive care, asthma severity, severity level of the DRG, winter admission, and length of stay. The cost breakdown showed that 44% constituted direct costs, 25% were indirect costs, 26% were attributed to medical procedures performed outside the patient unit, and 5% were related to medication administration. Conclusions: This study initiates a discussion on the role of reducing hospital costs in strategies aiming at controlling asthma-related costs. We argue that cost reduction cannot be achieved solely at the hospital level but must be approached from a public health perspective. This includes promoting high-quality outpatient care and addressing factors leading to poor adherence to the care plan.
ABSTRACT
INTRODUCTION: One of the main recommendations to improve chronic asthmatic patients' adhesion to their treatment is the implementation of a coordinated care pathway aiming at facilitating disease management by the patient while meeting his needs and expectations. PURPOSE OF RESEARCH: To study through a critical literature review and a short survey how this care pathway can be set up and adapted to the Belgian context. RESULTS: A model including the three healthcare levels in Belgium was developed. The first level is mainly formed by general practitioners while the second and third are centralized around a structure called asthma clinic. This latter would provide a full asthma assessment, its chronic follow-up and treatment for severe asthma. Roles of healthcare professionals working with the asthmatic patient were identified and described. This model is discussed in the light of the present Belgian situation according to different plans: asthma management, effective interdisciplinary communication, advanced nurse practitioner's role implementation. CONCLUSION: Although the Belgian context is currently not suitable enough for allowing this new nursing function to arise, our model lays the foundations of a system which is adapted to complexity of Belgium, follows from validated experiences on international scene, and offers an answer to chronic asthmatic patient's needs and expectations.
Subject(s)
Asthma , Asthma/therapy , Belgium , Critical Pathways , Disease Management , Humans , Surveys and QuestionnairesABSTRACT
INTRODUCTION: Poor treatment adherence among asthmatic patients currently remains a public health challenge. One of the most quoted determinants is the quality of the professional-patient relationship although it has clearly not been fully described. PURPOSE: This study aims at deeply exploring asthmatic patients' needs and expectations about the accompaniment proposed by their healthcare professionals. METHODS: A rigorous narrative review was performed. RESULTS: According to patients, what they expect from professionals can be split into eight themes: getting exhaustive information, relying on an available healthcare professional, being more involved into life with one's asthma, being accompanied by a multidisciplinary team, being respected in one's uniqueness, being cared through a humanist approach, feeling the professional is skilled and Other needs. DISCUSSION AND CONCLUSION: Asthmatic patients' needs have little evolved in 20 years illustrating that if they are met, that would positively affect the way patients want to be followed by healthcare professionals and so, that would increase their treatment adherence. Several recommendations such as setting up a doctor - asthma nurse practitioner binomial or studying a concrete care pathway may help in fulfilling these needs. Finally, this research opens the way to other studies since similar results have been found in populations suffering from other chronic diseases than asthma.
ABSTRACT
INTRODUCTION: Asthma remains a major public health problem, with 300 million people affected worldwide and a low rate of adherence to treatment. CONTEXT: Few authors have considered one of the determinants of asthmatic patients' adherence to treatment : the accompaniment offered by health care professionals. AIM: To describe the expectations and needs of people living with chronic asthma regarding their accompaniment. METHODS: A descriptive qualitative approach with reasoned sampling. Eight individual semi-structured interviews were conducted among chronic asthmatic adult patients and analyzed by an inductive approach. This was submitted to participants for validation. RESULTS: Needs and expectations are branched out into six main themes : the wish to establish a trusting relationship, the need to perceive professional competence, the importance of the professional's availability, the wish to be more involved in one's life with the disease, the desire for the professional to adopt a humanist posture and to take into account patient singularity. CONCLUSION: A better understanding of non-met expectations would help the adherence to treatment rate to improve. This qualitative research opens various avenues for reflection that are worth thinking about and provides the breeding ground for other studies.
