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Asthma APGAR tool improves patient, practice outcomes

Barbara P. Yawn

The Asthma Activities, Persistent, triGGers, Asthma medications, Response to therapy, or APGAR, tool was an “effective practice addition” for primary care physicians who treat patients with asthma, according to findings recently published in Annals of Family Medicine.

“Much of asthma care does not give patients what they need, and we continue to have high rates of ED visits and missed days of work and school,” Barbara P. Yawn, MD, MSc, of the department of research at the Olmsted Medical Center in Rochester, Minnesota, told Healio Family Medicine. “The old tools have not improved this problem. It was time for a new approach that addressed primary care specifically.”

Researchers randomly enrolled 1,066 patients aged 5 to 45 years from 18 practices to evaluate several patient and practice outcomes using the Asthma APGAR tool vs. usual care.

Yawn and colleagues found that of the 1,063 patients where data were available, the proportion of patients reporting hospital, urgent care, or an asthma-related ED visit in the last 6 months of the study declined in the practices utilizing Asthma APGAR vs. usual care (P = .004). This finding was surprising, according to Yawn.

“We did not expect to lower the rate of ED, urgent care and hospital visits by 50%. We were very pleased that use of this tool with limited preparation in the practices could have such a large impact,” she said in the interview.

Other findings included the percentage of patients with their asthma ‘in control’ went up between baseline and 1 year by 13.5% in practices where the Asthma APGAR was used vs. 3.4% in those receiving usual care (P = .0001 vs. P = .86) with a trend toward better control scores and asthma-related quality of life in patients where the Asthma APGAR was utilized.

In addition, of the 18 practices that completed the study, the nine that used APGAR improved their adherence to three or more guideline components vs. the usual care practices (20.7% increase vs. 1.9% decrease, P = .001).

Yawn acknowledged PCPs who choose to utilize the tool will face a learning curve.

“Practices that used the Asthma APGAR reported that it took some time to begin using the tool regularly (an hour of education and a week or so of figuring out how to include in practice) but once it was in use, the tools streamlined care. [The practices] reported that care was more efficient and both the team and the patient thought care was improved.”

“I hope [our findings are] a wake-up call — you can improve patients' outcomes and have a simple way to do it by using these tools. It helps reinforce the importance of assessing triggers, inhaler technique, allergies and adherence before just stepping up or adding more medicine,” she said.

Asthma APGAR is the only tool that improves both practice and patient outcomes, Yawn said. The paper version can be downloaded from the Annals of Family Medicine website, she added. – by Janel Miller

Disclosure: Yawn reports serving on asthma and COPD advisory boards for Boehringer, Ingelheim, GlaxoSmithKline, Novartis, and Teva. Please see the study for the other authors’ relevant financial disclosures.