Documentation of smoking in scheduled asthma contacts in primary health care: a 12-year follow-up study

Abstract

Smoking among asthmatics is common and associates with poorer asthma control, more rapid lung function decline and higher health care costs in dose-dependent manner. No previous real-life studies exist, however, on how smoking status and pack-years are documented in scheduled asthma contacts in primary health care (PHC) during long-term follow-up, and how often patients are advised to quit smoking. In this real-life 12-year follow-up study, we showed that out of all scheduled PHC asthma contacts (n = 603) smoking was mentioned only in 17.2% and pack-years only in 6.5%. Smoking data was not recorded even once in 70.9% of never smokers, 64.7% of ex-smokers and 27.3% of current smokers. Smoking including pack-years were mentioned more often if nurse took part on the scheduled contact. For current smokers, smoking cessation was recommended only in 21.7% of their scheduled contacts. Current smokers used more antibiotics and had more unscheduled health care contacts during follow-up.

Documentation of comorbidities, lifestyle factors, and asthma management during primary care scheduled asthma contacts

“…The results in this and our previous studies 22 , 32 suggest that implementation of the Finnish National Asthma Programme’s 31 main objectives has been partially successful in PHC, but room still exists for improvement (Fig. 3 ).…”

“…*Takala et al 22 . # Takala et al 32 . ǂ Self-care guidance includes patient asthma action plan instructions and lifestyle guidance.…”

“…All documented medication and data considering inhalation technique were manually collected from patient records and evaluated. Our previous studies described performance of lung function tests, documentation of smoking data and smoking cessation activities in scheduled asthma contacts in PHC 22 , 32 .…”

“…Consequently, most patients could use only public health-care services. Thus, in this and in our previous studies 22,23,32 , planned asthma follow-up contacts in health-care centres and in occupational health care were considered scheduled PHC contacts. All healthcare centres in the region had respiratory nurses and a coordinator GP responsible for asthma management in the health-care centre, yet all GPs managed their own asthma patients during the study period.…”

“…Our previous long-term study showed that adherence to lung function measurements, especially to spirometry, in assessing asthma control was high in PHC 22 . Conversely, the frequency of asthma follow-up contacts was insufficient 22 , as was smoking data and smoking cessation documentation 32 . Previous studies, mainly based on self-reports or short-term follow-ups, have suggested several shortcomings in asthma management in PHC, including asthma control assessment 30 , 33 , 34 , self-care guidance 33 , 34 , rhinitis screening and treatment 35 , 36 , inhaler technique review 30 , 34 and physical activity, nutrition and alcohol consumption assessment 34 .…”