Newsbriefs from the journal Chest, March 2006

MANY ASTHMATICS VIEW ASTHMA AS TEMPORARY, NOT CHRONIC, CONDITION
New research shows that many adults with asthma view their condition as temporary, believing they have asthma only when they have symptoms. Researchers from Mount Sinai School of Medicine, New York, NY, and Rutgers University, New Brunswick, NJ, surveyed 198 adult patients hospitalized with asthma regarding their asthma beliefs and behaviors and characteristics related to their beliefs. More than half of the patients indicated that they only had asthma when they were experiencing symptoms, a belief researchers labeled as, "no symptoms, no asthma." In contrast, 40 percent believed they had chronic asthma, while 6 percent indicated they had asthma most or some of the time. When asked about the lifelong nature of asthma, 20 percent of patients believed they would not always have asthma, and 15 percent expected the doctor to cure them of asthma. Male patients, those over 65 years old, and patients with no usual place of care were more likely to hold the "no symptoms, no asthma" belief. The belief also was associated with one-third lower odds of adherence to asthma medications during asymptomatic times. Researchers suggest that asthma interventions tailored to an individual's beliefs and behaviors may help with asthma management. The study appears in the March issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

GLUCOSE CONTROL YIELDS SIGNIFICANT SAVINGS FOR HOSPITALS
Intensive management of glucose levels in hospitalized critically ill patients can lead to decreased utilization of hospital resources and substantial cost savings. Researchers from Stamford Hospital, Stamford, CT, analyzed the economic impact of an intensive glycemic management protocol by comparing the clinical outcomes of 800 patients admitted to the intensive care unit (ICU) prior to the established protocol, with 800 patients admitted to the ICU after the protocol. Clinical outcomes reported in a previous study indicated a 29.3 percent decrease in hospital mortality for treated patients, as well as decreased ICU length of stay and ventilator days. In addition, treated patients showed decreases in all major areas of resource utilization, including laboratory, pharmacy, and diagnostic imaging. The annualized adjusted total cost savings amounted to $1.3 million, and the mean adjusted cost saving per patient was $1,580. Researchers believe that extending their findings to large numbers of ICUs could have a major impact on national health-care expenditures. The study appears in the March issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

PATIENTS ON MEDICAID FACE UNIQUE BARRIERS TO ASTHMA CARE
Medicaid-insured families face unique barriers to asthma management, including income level and insurance limitations. Researchers from the University of Michigan, Ann Arbor, MI, and the University of Utah, Salt Lake City, UT, evaluated focus group responses from 36 primary caregivers of children with asthma who were currently using or previously used Medicaid insurance. Of the participants, 23 (64 percent) were African-American, 32 (89 percent) were the biological mother, and 25 (69 percent) reported an annual income of less than $20,000. Overall, caregivers demonstrated a high level of asthma knowledge but also identified unique barriers to asthma management, including difficulty maintaining continuity of care due to physician participation in Medicaid programs; concerns about possible differences in asthma care from health-care providers due to their Medicaid insurance status; and the inability to afford asthma supplies. A specific gap also was seen in the caregiver's level of self-efficacy to control exposure to asthma triggers, monitor the child's symptoms, and modify medications based on asthma symptoms. To overcome these barriers, researchers suggest that physicians employ strategies that demonstrate to patients and caregivers that decisions for care are not based on the type of patient insurance. The study appears in the March issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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