Online “Asthma PACT” Helps Patients and Parents

(Washington, DC – November 22, 2011)  The Asthma PACT™  (Personal Assessment and Control Tool) available at www.AsthmaPACT.org, is a free online program hosted by the Asthma and Allergy Foundation of America (AAFA) that helps patients and parents reduce the cost and suffering from asthma.  The concept is simple: individuals with asthma must follow directions from their medical providers, including medications to take, to properly treat this chronic disease.  The Asthma PACT helps patients and parents to identify reasons why they may be having difficulty following the treatment plan, and it gives feedback – in written and video formats – about how to manage these problems.  Individuals can print their personal assessment and take it to their medical provider for further discussion.  Jacqui Vok, AAFA’s Senior Educational Programs Manager, says, “Placing the Asthma PACT personalized assessment in the hands of their physicians empowers patients to get the advice they need to help them manage their asthma symptoms.”  The Asthma PACT is a validated asthma adherence survey that is currently being used in research projects at the National Institutes of Health (NIH).

“Each patient is their own cost center,” says Andrew Weinstein, MD, a Board Certified allergist and President of Adherence Management Systems (AMS), developer of the Asthma PACT tool.  “By focusing on why you have persistent symptoms, you can improve your health and reduce your cost of care.”  Also, according to Weinstein, the Asthma PACT “helps the patients self-identify the ‘rough areas’ and acts as a vehicle to bring potential solutions to the individual and family.”

An estimated 25 million Americans have asthma, 7.1 million under the age of 18. The annual cost of care is estimated at $19.7 billion, with 456,000 hospitalizations and 1.5 million ER visits.  African Americans are three times more likely to be hospitalized or die from asthma. Inhaled corticosteroids effectively control symptoms and reduce morbidity, mortality, health care utilization and costs.

The Right Tool for a Big Problem

Weinstein treated 59 children with severe asthma in an inpatient rehabilitation setting at the Alfred I. duPont Hospital for Children.  The year prior to treatment, the median cost per patient was $10,240.  Each child had seven hospital days and four emergency room visits.  At all four years of follow-up, median hospital days and emergency room visits were zero.  The cost of care fell below $2,000 at the end of the fourth year.  The key to the success of the program was the ability of the health care team to identify the difficulties that the family was experiencing following the treatment plan and helping them become successful.

These outcomes were duplicated in the outpatient setting in children with severe asthma at the same hospital and in adult patients with severe asthma referred by Blue Cross Blue Shield Delaware.   Weinstein transferred the analytic questions from his adherence care model and, in partnership with AAFA, made it available online as the Asthma PACT at no charge for all asthma patients and parents.

Adherence - The Key to Controlling Healthcare Costs

Despite high-profile discussions to control healthcare costs, there is little emphasis on the contributors to high costs, nor the actions that can be taken to reduce costs.  Individuals with chronic diseases such as asthma, diabetes and heart disease are responsible for more than 80% of all health care costs due to medications, physician visits, hospitalizations, emergency care, and disability caused by these diseases.  It has long been observed that 45-60 percent of individuals with these chronic diseases do not follow their prescribed medication plans, called “non-adherence” or “non-compliance,” which further adds an estimated $600 million to the annual cost of care in the U.S.

Experts have identified more than twenty reasons why so many asthma patients are non-adherent; however, a partial list includes - cost; comprehension of instructions; concern about side effects; lack of support; emotional response to symptoms; disagreeing with the diagnosis; and believing the medication is ineffective.

Asthma PACT Increases Adherence, Decreases Costs

The Asthma PACT includes 75 percent of these “reasons for non-adherence” and presents them in an organized way to the patient and provider.  One problem area that is now beginning to be addressed by medical schools and residency programs is the lack of counseling skills by practicing physicians.  The personnel in the asthma rehabilitation program mentioned above had psychological training to help the families work through the obstacles that were preventing them from consistently giving the medication. Most individuals with asthma do not have significant psychological issues and can be helped by practitioners with basic counseling skills. But the key to education and counseling is to know why individuals are not following the directions.  This is the value of the Asthma PACT in preventing sleepless nights, work and school absence and unnecessary emergency and hospital care and healthcare costs.  “Asthma PACT™” and “AsthmaPACT.org” are trademarks of the Asthma and Allergy Foundation of America (AAFA).

About AAFA

The Asthma and Allergy Foundation of America (AAFA), a not-for-profit organization founded in 1953, is the leading patient organization for people with asthma, allergies and related conditions.  AAFA is dedicated to improving the quality of life for patients through education, advocacy and research.  AAFA provides practical information, community based services and support through a network of regional chapters, support groups and other local partners around the United States.  For more information, visit www.aafa.org.

About AMS

Adherence Management Systems (AMS) provides Adherence/Communication training for physicians, nurse practitioners and physician assistants to improve patient outcomes and satisfaction with care.  The faculty includes physicians who present proven clinical management strategies and communication skills to yield improved adherence to treatment.

Education Program

The education program includes a comprehensive review of barriers associated with poor adherence: concerns about medication, poor comprehension of instructions, cost, lack of confidence with providers of care, lack of support, depression, anxiety, poor quality of life and other issues.  Trainees learn adherence strategies (tailoring, incentive contracts, assessing health beliefs and monitoring (questionnaire/electronic for metered-dose-inhalers), from video examples and by role-playing with fellow students.  The clinician learns to recognize non-adherence patterns (erratic, intelligent and unwitting) and specific strategies appropriate for each behavioral pattern.  Attendees learn basic elements of Motivational Interviewing techniques to facilitate the delivery of the adherence strategies presented in the curriculum.  These techniques include the use of open-ended questions, reflections, assessing patient readiness to accept health care instruction, expressing empathy, managing patient ambivalence, avoiding confrontation, and promoting self-efficacy.  Length of training varies from a 3 hour workshop to 2 to 3 day intensive learning.

Clinical Tools Amplify Education Program

Adherence Training Software – AMS has developed web-based software which enables clinicians to be more effective in managing patients and promoting adherence.  The Asthma Adherence Clinical Pathway™ (AACP) is completed by the patient who identifies high-risk factors listed above which might result in patient non-adherence.  Clinicians review the patient responses and are directed to strategies, presented in the training to manage the patient. Case examples derived from the AACP are utilized in the training process.  The AACP is available to students after the training is completed.  The software also includes: 1) an asthma information section for the patient; 2) a patient asthma information test to identify specific areas of need for asthma education; 3) a quality of life instrument which may be repeated to assess patient improvement.

Medication Monitoring

AMS has been developing an Adult Asthma Adherence Questionnaire and is a participant in a National Institutes of Health research trial Grant #7R44HL078252-05.  When validated, this tool will assist clinicians in determining the adherence status of the patients they are evaluating.  AMS also utilizes electronic monitors for MDIs to assist clinicians in diagnosing adherence status.  They track the date and time of use. For symptomatic patients these devices are able to distinguish between treatment failure from non-adherence.