Rapid reduction in hospitalisations after an intervention to manage severe asthma

Abstract

Asthma is the third cause of hospitalisations due to clinical illnesses in Brazil. The Programme for Control of Asthma in Bahia (ProAR) leads an initiative in Salvador City (Brazil) to manage severe asthma for free. The aim of this study was to identify trends in asthma hospitalisation in the entire city and to evaluate the impact of ProAR.Information on asthma hospitalisations from 1998 to 2006 was collected. We analysed trends in Salvador (2.8 million inhabitants) before and after ProAR, taking pneumonia and myocardial infarction into account for local comparison. As an external control we obtained information on asthma from Recife, which is the most comparable Brazilian city.In Salvador, asthma hospital admissions declined by 82.3% (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). A greater proportion of this reduction (74%) occurred after 2003, in parallel with the implementation of ProAR. The reduction in asthma admissions in Recife was smaller. The rates of hospitalisation in 2006 were 2.25 per 10,000 inhabitants in Salvador and 17.06 in Recife. In Salvador, we found an inverse correlation between the provision of medication for asthma and hospitalisation (-0.801; p,0.0001).A rapid reduction in asthma admissions in the entire city of Salvador was associated with ProAR, a public health intervention targeting severe asthma.

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk Souza-Machado et al 235 report a public health intervention project supported by the Brazilian Ministry of Health and the Salvador city authorities, which promoted individual/group patient education, training for GPs and pharmacists, and free consultations and prescriptions. 235 The intervention was associated with a rapid reduction in asthma admissions and reversal of the previously increasing mortality rate in contrast to rising mortality and a small reduction in admissions in a similar control city.…”

“…We included 19 papers reporting 18 studies (see Table 116 for details) nine of which were conducted in the USA, 219,220,[222][223][224][225]230,231,234 four from the UK, 218,226,228,236 two from Brazil, 229,235 one (two reports) from Finland 232,233 and two from other European countries. 221,227 The majority (n = 9) were conducted in primary care or community settings, 218,219,226,228,229,[234][235][236] four in managed care organisations (MCOs), 220,222,223,225 one in secondary care, 230 three in schools 221,224,231 and one (two reports) was a national multisetting initiative.…”

“…Three studies used population data to observe the impact of multifaceted public health programmes on admissions, 229,232,233,235 two quality improvement projects aimed to promote asthma self-management 230,236 and two complex interventions targeted low-income communities in US cities. 231,234 A national programme to improve asthma care in Finland 232,233 included a strong focus on self-management education, in the context of widespread professional education-and systems-level expectations of raising the quality of asthma diagnosis and management.…”

“…221,227 The majority (n = 9) were conducted in primary care or community settings, 218,219,226,228,229,[234][235][236] four in managed care organisations (MCOs), 220,222,223,225 one in secondary care, 230 three in schools 221,224,231 and one (two reports) was a national multisetting initiative.…”

“…228 Seven were based on longitudinal data, 220,223,[230][231][232][233][234][235] one with a control cohort, 229 and two uncontrolled before-and-after 221,236 or cross-sectional studies. 227 This resulted in substantial variation in quality assessment, ranging from 10 to 24 out of a possible score of 28.…”