Diabetes. 10.4% Coronary atherosclerosis. 9.4 positive correlation between asthma and type 1 diabetes.5 The presence of these …
Asthma
The impact of multiple chronic conditions
Introduction
According to a 2001 survey by the Center for Disease Control and
Prevention, there are approximately 313 million Americans diagnosed with
asthma at some point during their lifetime[1] Among all the age groups,
children 5-17 years of age have the highest prevalence rates[2] Asthma
is the leading cause of school absences from a chronic illness It
accounts for an annual loss of more than 10 million school days per year
and more hospitalizations than any other childhood disease Children with
asthma spend an estimated 73 million days per year restricted to bed[3]
Most People With Asthma have other Chronic Conditions
According to Figure 1, over two thirds of people with asthma have one
or more other chronic conditions, and more than half of the asthmatics
have two or more in addition to asthma However, little attention has
been paid to the issue of co-morbidities among asthmatic patients The
most common co-morbidities are shown in Table 1
|Table 1 | |
|Conditions |Percent of |
| |Asthma |
|
|Patients |
| |Affected |
|Hypertension |259 |
|Hyperlipidemia, |184 |
|hyperglyceridemia, | |
|hypercholesterolemia and| |
|other disorders of lipid| |
|metabolism | |
|COPD |161 |
|Diabetes |104 |
|Coronary atherosclerosis|94 |
As seen in Figure 2, more than 80 percent of asthmatics age 0-17 have
no co-morbidities However, the prevalence of co-morbidities increases
with age By the time the population has reached age 65, only 6 of people
have asthma only The number of people
Source: Large Private Insurer, CY 2001
with 5 or more chronic conditions in addition to asthma also increases
with age One percent of children seventeen or less have five or more
other chronic conditions, by the time the population has reached 65, more
than one third of the population have more than five other chronic
conditions in addition to asthma
Theres some limited clinical research discussing the impact of co-
morbidities on treating asthmatics As shown in Table 1, slightly more
than a quarter of asthma patients have hypertension, and some studies have
suspected the possibility of a positive correlation[4] Other studies have
shown a positive correlation between asthma and type 1 diabetes[5] The
presence of these co-morbidities may complicate treatment; however,
information on treating asthma patients with other chronic conditions is
limited Nevertheless, improving the quality of treatment remains an
important issue, since research has already shown that co-morbidities,
especially cardiac disease and hypertension, result in poor health-related
quality of life HRQoL in asthma patients[6]
Health Care Spending Increases With Number of Chronic Conditions
Figure 3 shows that spending on people with asthma increases with the
number of chronic conditions People with asthma and five or more chronic
conditions have approximately eight times more expenditures per enrollee
compared to enrollee with only asthma
Hospitalization Rates Increase as the Number of Chronic Conditions
Increases
|Table 2 | |
|Number of Chronic |Hospitalization|
| |s for |
|Conditions in |ACSC Admissions|
|Addition
to Asthma |per 1000 |
| | |
|0 |111 |
|1 |188 |
|2 |330 |
|3 |582 |
|4 |931 |
|5 |2587 |
Source: Large Private Insurer, CY 2001
Many asthmatics have one or more ambulatory care-sensitive conditions,
or ACSCs ACSCs are defined as conditions for which diagnoses for which
timely and effective outpatient care can help to reduce the risks of
hospitalization by either preventing the onset of an illness or condition,
controlling an acute episodic illness or condition such as bacterial
pneumonia, or managing a chronic disease or condition such as asthma and
hypertension[7]
It has been observed that better primary care, especially
coordination of care, could reduce avoidable hospitalization rates,
especially for individuals with multiple chronic conditions[8]
Hospitalization for conditions ACSCs that are preventable can be
used to indicate whether the patient is receiving adequate and quality
outpatient care[9]
Utilization Increases with Number of Chronic Conditions
People with multiple chronic conditions in addition to asthma utilize
more healthcare resources As Figure 4 shows, patients with more chronic
conditions visit doctors more often As shown in Figure 5, patients with
five or more chronic conditions in addition to asthma see nearly three
times as many doctors as does a patient with asthma alone
Coordination of Care: The Concept of Medical Home
The American Academy of Pediatrics AAP, defines medical home as a
place where medical care is accessible, continuous, comprehensive, family-
centered, coordinated[10], compassionate and culturally effective[11] Lack
of a medical home may cause unnecessary hospitalizations; in fact, research
has demonstrated that hospitalization due to acute severe asthma
represents a failure in the preventive, long-term as well as home care of
asthma[12] Care in the context of a medical home is also more cost-
effective, as the AAP points out: care provided through emergency
departments, walk-in clinics, and other urgent-care facilitiesis more
costly and often less effective[13]
Conclusion:
Treatment has become increasingly difficult when asthma patients have
other chronic conditions Research
suggests that patients have better
outcomes at lower cost when care is coordinated[14] Care coordination
becomes essential to improvements in care for patients with lung cancer
About Partnership for Solutions
Partnership for solutions, led by Johns Hopkins University and the
Robert Wood Johnson Foundation, is an initiative to improve the care and
quality of life for the estimated 125 million Americans with chronic health
conditions The Partnership is engaged in three major activities conducting
original research and identifying existing research that clarifies the
nature of the problem; communicating these research finding to
policymakers, business leaders, health professionals, advocates, and
others; and working with public and private programs to identify promising
solutions to the problems faced by people with chronic conditions
———————–
[1] Trends in Asthma Morbidity and Mortality American Lung Association,
Accessed July 2003, http://wwwlungusaorg/data/asthma/asthma1pdf p5
[2] Ibid
[3] Asthma Facts and Figures Asthma and Allergy Foundation of America,
Accessed July 2003, http://wwwaafaorg/templ/displaycfm?id2sub29
[4] Salako BL, Ajayi SO 2000 Bronchial
asthma: a risk factor for
hypertension? Afr J Med Med Sci 291: 47-50
[5] Stene LC, Nafstad P2001 Relation between occurrence of type 1
diabetes and asthma Lancet 24;3579256:607-8
[6] HA Wijnhoven et al 2003 The influence of co-morbidity on health-
related quality of life in asthma and COPD patients Respir Med 975: 468-
75
[7] Billings J, Zeitel L, Lukomnik J, Carey TS, Blank AE, Newman L Impact
of socioeconomic status on hospital use in New York City Health
AffairsMillwood 1993:12:p163-166
[8] Anderson G, Starfield B, and Wolff J 2002 Prevelence, Expenditures,
and Complications of Multiple Chronic Conditions in the Elderly Arch
Intern Med 16220: 2269-76
[9] Millman M Access to Health Care in America Washington, DC: National
Academy Press; 1993
[10] American Academy of Pediatrics, Committee on Children With
Disabilities Care coordination: integrating health and related systems of
care for children with special health care needs Pediatrics 1999; 104:978-
981
[11] American Academy of Pediatrics, Committee on Pediatric Workforce
Culturally effective pediatric care: education and training issues
Pediatrics 1999;103:167-170
[12] Singh M 2001 Management of acute asthma Indian J Pediatr 68
Suppl
4: S23-30
[13] American Academy of Pediatrics, Medical Home Initiatives for Children
With Special Needs Project Advisory Committee The Medical Home
Pediatrics 2002;110:184-186
[14] Anderson G, Starfield B, and Wolff J Prevalence, Expenditures, and
Complications of Multiple Chronic Conditions in the Elderly Arch Intern
Med Vol 162, Nov 2002, p 2275
———————–
August
2003
Source:partnershipforsolutions.org
