Key Point

Adherence to Spanish-language guidelines among Hispanic patients with asthma results in improved commitment to treatment of the condition, as well as to substantial reductions in health care costs.

MONTREAL—Goal-oriented management of asthma, based on Spanish-language guidelines, generates commitment to optimal asthma management in Puerto Rican patients and results in substantial savings in health care costs, reported Ramón E. Figueroa-Lebrón, MD, FCCP, at the annual meeting of the American College of Chest Physicians.¹

Asthma is a common health problem in Puerto Ricans living in the mainland United States and Puerto Rico, causing substantial morbidity and mortality. Furthermore, limited data suggest that there are inadequacies in asthma education and in management of the condition among Hispanic patients.²

Because "the absence of simple goals is the cause of poor asthma management," Dr. Figueroa-Lebrón developed a set of goal-oriented guidelines—written in both English and Spanish—which he calls the Asthma Patient Bill of Rights. "I realized that even with the NIH guidelines and the introduction of several good medications, physicians were still spinning with what was the best way to control their patients’ asthma. I realized we needed a comprehensive but simple tool that, in lay terms, could help patients and physicians. My Asthma Patient Bill of Rights is such a tool," he said.

Dr. Figueroa-Lebrón, of the Asthma Management Center in San Juan, Puerto Rico, examined expenditures paid from 2003 to 2004 by Blue Shield Puerto Rico for services—including office visits, emergency department and ICU admissions, medications, readmissions, and therapeutic/diagnostic procedures—provided for the treatment of asthma. He compared the efficacy of the Spanish version of the Asthma Patient Bill of Rights—the Carta de Derechos del Paciente Asmático (CDPA)—with that of current guidelines supported by the National Asthma Education and Prevention Program (NAEPP).

In assessing the data, Dr. Figueroa-Lebrón grouped the study population into those treated by 108 pneumologists with presumed knowledge of NAEPP guidelines in private offices (n = 24,320) and those treated by a team consisting of a physician, therapist, nurse, and assistant (n = 1,094). Each patient in the latter group, as well as each of his or her health care providers, received a copy of the CDPA. Patients spoke Spanish as their principal language. According to Dr. Figueroa-Lebrón, the NAEPP guidelines are not accessible to patients, nor are they available in Spanish.

HOW EFFECTIVE IS THE CDPA?

Dr. Figueroa-Lebrón found that patients in the goal-oriented group had lower health care expenses than those in the standard therapy group, with a savings of approximately $3 million.

None of the patients in the goal-oriented group was readmitted within 15 days of discharge, compared with 20% of patients in the standard therapy group. No deaths occurred in the goal-oriented group. In the standard therapy group, deaths occurred more frequently at home or in route to the hospital than in the ICU, reported Dr. Figueroa-Lebrón.

Because poor adherence to current NAEPP guidelines has created unsatisfactory asthma control and inadequacies in prescription patterns and patient education, Dr. Figueroa-Lebrón recommended that the CDPA be adopted as standard care for all Hispanic patients.

—Karen L. Spittler

References
1. Figueróa-Lebrón RE. No Hispanic asthmatic left behind. Presented at: annual meeting of the American College of Chest Physicians; November 2, 2005; Montreal, Quebec.
2. Hunninghake GM, Weiss ST, Celedón JC. Asthma in Hispanics. Am J Respir Crit Care Med. 2006;173:143-163.

Return to table of contents