Documentation of the Management of Asthma Exacerbation in Adults by Primary Health Care Physicians in a Teaching Hospital in Oman

Abstract

Objectives: Asthma exacerbation is a major cause of morbidity and it is usually an indication of poor control. Appropriate management and documentation of the clinical assessment of an exacerbation, its severity,contributing factors and treatment are all essential components of asthma control. The aim of this study was to assess the documentation of the management of asthma exacerbations by primary care physicians (PCPs). Methods:A retrospective analysis was carried out on patient records from 1 May 2008 to 31 April 2009. We included all acute exacerbation episodes in asthmatic patients aged ≥ 14, who received nebulized bronchodilators in the two family medicine clinics attached to Sultan Qaboos University Hospital (SQUH), Oman. A special form was designed to collect PCP's documented management. Results: A total of 67 patients with 100 episodes were treated by 42 PCPs. Documentation of clinical assessment was low for previous admissions (2%), rescue nebulization (25%), duration of symptoms (57%), trigger factors (19%), compliance (9%), clinical signs (48%), peak flow rate (3%), and inhaler technique (5%). The diagnosis of asthma exacerbation was documented in 77% of the episodes.Documentation of therapy was also low (3% for oxygen therapy and 24% for systemic steroids). Documentation of post-nebulization assessment, follow-up appointment, and referral to asthma clinic were found in 37%, 23% and 11% of cases respectively. No documented evidence was found for referral to chest specialist or spirometry. Conclusion: Our study indicates major deficiencies in the documentation of asthma exacerbation management among PCPs. Further research is needed to identify the causes of those deficiencies. Following the standardised management protocol can be helpful.