ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Patterns of Care and Factors Associated with Care Specialty in Individuals with Asthma Who Required Hospitalization: A Retrospective Population-Based Study
Session Title
A7 - A007 IMPACT OF RACE, ETHNICITY, AND SOCIAL DETERMINANTS ON INDIVIDUALS WITH LUNG DISEASES
Abstract
A1036 - Patterns of Care and Factors Associated with Care Specialty in Individuals with Asthma Who Required Hospitalization: A Retrospective Population-Based Study
Author Block: T. Kendzerska1, S. D. Aaron2, M. Meteb3, A. S. Gershon4, T. M. To5, M. Lougheed6, H. Tavakoli7, W. Chen8, E. Kunkel9, M. Sadatsafavi10, Canadian Respiratory Research Network; 1Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada, 2The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada, 3The Ottawa Hospital Research Institute, Ottawa, ON, Canada, 4Sunnybrook Health Sciences Centre, ICES, Toronto, ON, Canada, 5Hosp for Sick Children, Toronto, ON, Canada, 6Kingston General Hospital Research Institute, Queen’s University, Kingston, ON, Canada, 7Pharmaceutical Sciences, University f British Columbia, Vancouver, BC, Canada, 8Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada, 9The Ottawa Hospital Research Institute, ICES, Ottawa, ON, Canada, 10Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.
Introduction Asthma exacerbations that require hospitalization are watershed moments in the life of individuals with asthma. Although hospitalized asthma should prompt specialist referrals given potential benefits, there is a lack of referrals to specialists in practice. Thus, our primary aim was to assess the proportion of individuals with asthma who required hospitalization at some point during their course of asthma, being seen by a specialist before and after their initial asthma diagnosis. The secondary aim was to identify factors associated with receiving asthma specialist care.
Methods We conducted a retrospective population-based study using health administrative data from two Canadian provinces on individuals aged 14 to 45 years who were newly diagnosed with asthma between 2006 and 2016 and had at least one hospitalization for asthma within five years following their initial asthma diagnosis. We followed those individuals until March 31, 2018, or death. We described the proportion of individuals seen by primary and specialist care physicians one year prior and two years after the asthma diagnosis. We used multivariable Cox regression analysis to model the time from the asthma diagnosis to the first asthma-related specialist visit among individuals who did not receive specialist care before their asthma diagnosis.
Results We included 1,862 individuals in our study (mean age 31, 64% female) and followed them by an average of 86 months since the asthma diagnosis. The mean time from the asthma diagnosis to a specialist visit was 11 months (SD: 19). Before the initial asthma diagnosis, 1,411/1,862 (76%) of individuals were under primary care physicians' care. Among those, 858/1,411 (61%) were cared for by both primary care physicians and specialists, and 553/1,411 (39%) never received specialist care for their asthma since the diagnosis. The percentage of patients seen by primary and specialist care physicians over time was similar between the two provinces (Figure). Individuals living in a rural area (vs. urban: adjusted HR 0.58, 95% CI:0.46-0.72) or a low-income neighbourhood (vs. high: adjusted HR 0.86; 95% CI:0.73-1.00) were less likely to receive specialist care.
Conclusions Despite guideline recommendations, 39% of individuals with asthma who experienced at least one exacerbation required hospitalization did not receive specialist care over an average of about seven years since their initial asthma diagnosis. Living in a rural area and socioeconomic status were the strongest factors associated with a reduced likelihood of receiving specialist care, suggesting access is an important barrier to receiving the recommended care.
Author Block: T. Kendzerska1, S. D. Aaron2, M. Meteb3, A. S. Gershon4, T. M. To5, M. Lougheed6, H. Tavakoli7, W. Chen8, E. Kunkel9, M. Sadatsafavi10, Canadian Respiratory Research Network; 1Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada, 2The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada, 3The Ottawa Hospital Research Institute, Ottawa, ON, Canada, 4Sunnybrook Health Sciences Centre, ICES, Toronto, ON, Canada, 5Hosp for Sick Children, Toronto, ON, Canada, 6Kingston General Hospital Research Institute, Queen’s University, Kingston, ON, Canada, 7Pharmaceutical Sciences, University f British Columbia, Vancouver, BC, Canada, 8Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada, 9The Ottawa Hospital Research Institute, ICES, Ottawa, ON, Canada, 10Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.
Introduction Asthma exacerbations that require hospitalization are watershed moments in the life of individuals with asthma. Although hospitalized asthma should prompt specialist referrals given potential benefits, there is a lack of referrals to specialists in practice. Thus, our primary aim was to assess the proportion of individuals with asthma who required hospitalization at some point during their course of asthma, being seen by a specialist before and after their initial asthma diagnosis. The secondary aim was to identify factors associated with receiving asthma specialist care.
Methods We conducted a retrospective population-based study using health administrative data from two Canadian provinces on individuals aged 14 to 45 years who were newly diagnosed with asthma between 2006 and 2016 and had at least one hospitalization for asthma within five years following their initial asthma diagnosis. We followed those individuals until March 31, 2018, or death. We described the proportion of individuals seen by primary and specialist care physicians one year prior and two years after the asthma diagnosis. We used multivariable Cox regression analysis to model the time from the asthma diagnosis to the first asthma-related specialist visit among individuals who did not receive specialist care before their asthma diagnosis.
Results We included 1,862 individuals in our study (mean age 31, 64% female) and followed them by an average of 86 months since the asthma diagnosis. The mean time from the asthma diagnosis to a specialist visit was 11 months (SD: 19). Before the initial asthma diagnosis, 1,411/1,862 (76%) of individuals were under primary care physicians' care. Among those, 858/1,411 (61%) were cared for by both primary care physicians and specialists, and 553/1,411 (39%) never received specialist care for their asthma since the diagnosis. The percentage of patients seen by primary and specialist care physicians over time was similar between the two provinces (Figure). Individuals living in a rural area (vs. urban: adjusted HR 0.58, 95% CI:0.46-0.72) or a low-income neighbourhood (vs. high: adjusted HR 0.86; 95% CI:0.73-1.00) were less likely to receive specialist care.
Conclusions Despite guideline recommendations, 39% of individuals with asthma who experienced at least one exacerbation required hospitalization did not receive specialist care over an average of about seven years since their initial asthma diagnosis. Living in a rural area and socioeconomic status were the strongest factors associated with a reduced likelihood of receiving specialist care, suggesting access is an important barrier to receiving the recommended care.
