Comparing the Asthma APGAR system and the Asthma Control Test™ in a multicenter primary care sample

Mayo Clin Proc. 2014 Jul;89(7):917-25. doi: 10.1016/j.mayocp.2014.02.016. Epub 2014 May 5.

Abstract

Objective: To compare asthma control assessment using the Asthma APGAR system, a tool developed by primary care clinicians, in a multicenter primary care sample with the Asthma Control Test (ACT™)/Childhood Asthma Control Test (CACT™), a tool developed by asthma specialists.

Patients and methods: This is a substudy of a multicenter, randomized, controlled pragmatic trial that tests the effectiveness of the Asthma APGAR system in primary care practices. As part of the study, enrolled patients completed both the ACT™/CACT™ and the Asthma APGAR system between March 1, 2011, and December 31, 2011. Kappa and McNemar statistics were used to compare the results of questionnaires.

Results: Of the 468 patients in our sample, 306 (65%) were classified as not controlled by the ACT™/CACT™ or the Asthma APGAR system. The overall agreement was 84.4%, with a kappa value of .68 (substantial agreement) and a McNemar test P value of .35 (suggesting no significant difference in the direction of disagreement). Of those with poor control as defined by the Asthma APGAR system, 23.8% (73) had no controller medications and 76.5% (234) were seldom or sometimes able to avoid identified triggers for their asthma. Of those who stated that they had been prescribed controller medications, 116 of 332 (35%) stated that they did not use the controller medication on a daily basis.

Conclusion: The Asthma APGAR system and the ACT™/CACT™ similarly assess asthma control in a multicenter primary care-based sample. The Asthma APGAR system identified an "actionable item" in more than 75% (234) of the individuals with poor asthma control, thus linking an assessment of poor asthma control with a management strategy.

Trial registration: ClinicalTrials.gov NCT01446315.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Algorithms
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / diagnosis*
  • Asthma / drug therapy
  • Asthma / etiology
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Decision Support Techniques*
  • Drug Monitoring / methods
  • Female
  • Humans
  • Logistic Models
  • Male
  • Medication Adherence
  • Middle Aged
  • Primary Health Care*
  • Risk Factors
  • Severity of Illness Index*
  • Surveys and Questionnaires*
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Asthmatic Agents

Associated data

  • ClinicalTrials.gov/NCT01446315