E.TAN1, N. MAGANLAL1, J.R.RAMASAMY1, C.L.LEE1
NHGP delivers asthma-care using team-based care (TBC) and non-team based care (NTBC) approaches. We hypothesized that TBC approach would improve both process and outcome indicators.
Data from NHGP Information and Analysis Department was used to compare process indicators [Asthma Control Test (ACT) documentation, smoking assessment] and outcome indicators [Dispensed Preventer: Reliever (P: R) ratio;% patients with ACT score≥20;% of patients requiring nebulization (nebulization rate)] from July 2019 to June 2021. The medians for each indicator were compared and paired t-test was used for significance testing.
Comparing TB to NTB care, the median process indicator rates were significantly better for TBC in-terms of ACT documentation rate (58% vs 40%, p<0.05, target 100%) and smoking assessment rate (91% vs 83%, p<0.05, target 100%). Similarly, outcome indicators were significantly better for TB care: P: R ratio (2.9 vs 2.2, p<0.05, target ≥2 );% patients with ACT > 20 (90% vs 76%, p<0.05, target ≥ 85%); Nebulization rate (3% vs 6%, p<0.05, target ≤ 5%).
Clinical outcomes and documentation of risk factors are consistently and significantly better in TB care, with outcome indicators of P: R ratio, % patients with ACT ≥20 and nebulization rate exceeding institutional set targets.
Reasons may include:
Smaller and consistent care teams build better rapport with patients and empower them to improve asthma control. TBC coordinators enhance defaulter tracking and minimize patients lost to follow up.
Implementation and support to empanel more asthma patients into TBC should continue. Subsequent longitudinal studies are required to assess sustainability and long-term outcomes.