Effect of a web-based chronic disease management system on asthma control and health-related quality of life: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Asthma is a prevalent and costly disease resulting in reduced quality of life for a large proportion of individuals. Effective patient self-management is critical for improving health outcomes. However, key aspects of self-management such as self-monitoring of behaviours and symptoms, coupled with regular feedback from the health care team, are rarely addressed or integrated into ongoing care. Health information technology (HIT) provides unique opportunities to facilitate this by providing a means for two way communication and exchange of information between the patient and care team, and access to their health information, presented in personalized ways that can alert them when there is a need for action. The objective of this study is to evaluate the acceptability and efficacy of using a web-based self-management system, My Asthma Portal (MAP), linked to a case-management system on asthma control, and asthma health-related quality of life.</p> <p>Methods</p> <p>The trial is a parallel multi-centered 2-arm pilot randomized controlled trial. Participants are randomly assigned to one of two conditions: a) MAP and usual care; or b) usual care alone. Individuals will be included if they are between 18 and 70, have a confirmed asthma diagnosis, and their asthma is classified as not well controlled by their physician. Asthma control will be evaluated by calculating the amount of fast acting beta agonists recorded as dispensed in the provincial drug database, and asthma quality of life using the Mini Asthma Related Quality of Life Questionnaire. Power calculations indicated a needed total sample size of 80 subjects. Data are collected at baseline, 3, 6, and 9 months post randomization. Recruitment started in March 2010 and the inclusion of patients in the trial in June 2010.</p> <p>Discussion</p> <p>Self-management support from the care team is critical for improving chronic disease outcomes. Given the high volume of patients and time constraints during clinical visits, primary care physicians have limited time to teach and reinforce use of proven self-management strategies. HIT has the potential to provide clinicians and a large number of patients with tools to support health behaviour change.</p> <p>Trial Registration</p> <p>Current Controlled Trials <a href="http://www.controlled-trials.com/ISRCTN34326236">ISRCTN34326236</a>.</p

A COMPARISON OF MORBIDITY PATTERNS IN PUBLIC AND PRIVATE PRIMARY CARE CLINICS IN MALAYSIA

Objectives: To compare the morbidity patterns in public and private primary care clinics; determine patients’ reasons forencounter (RFE) and diagnoses using the ICPC-2, and compare ten commonest diagnoses and RFEs.Methods: A cross-sectional study on randomly selected clinics was conducted nationwide. Doctors completed the PatientEncounter Record (PER) for systematically selected encounters for a week.Results: Response rate was 82.0% (public clinic) and 33% (private clinic) with 4262 encounters and 7280 RFE. Overall, thethree commonest disease categories encountered were respiratory (37.2%), general and unspecified (29.5%), and cardiovasculardiseases (22.2%). Public and private clinics handled 27% versus 50% acute cases and 20.0% versus 3.1% chronic cases i.e.33.7 and 5.6 chronic diseases per 100 RFE respectively.Conclusion: Doctors in public clinics saw more chronic and complex diseases as well as pregnancy related complaints andfollow-up cases while in private clinics more acute and minor illnesses were seen. Health services should be integrated andsupport given to co-manage chronic diseases in both sectors

Preventing adolescents from adopting HIV-related risky sexual behaviours: Do we have all the answers?

10.1177/10105395060180010101Asia-Pacific Journal of Public Health1811-