SOCIOECONOMIC DISADVANTAGE, QUALITY OF MEDICAL-CARE AND ADMISSION FORACUTE SEVERE ASTHMA

Background: In asthma, socio-economic and health care factors may oper ate by a number of mechanisms to influence asthma morbidity and mortal ity. Aim: To determine the quality of medical care including the patie nt perception of the doctor-patient relationship, and the level of soc io-economic disadvantage in patients admitted to hospital with acute s evere asthma. Methods: One hundred and thirty-eight patients (15-50 ye ars) admitted to hospital (general ward or intensive care unit) with a cute asthma were prospectively assessed using a number of previously v alidated instruments. Results: The initial subjects had severe asthma on admission (ph=7.3+/-0.2, PaCO2=7.1+/-5.0 kPa, n=90) but short hospi tal stay (3.7+/-2.6 days). Although having high morbidity (40% had hos pital admission in the last year and 60% had moderated/severe interfer ence with sleep and/or ability to exercise), they had indicators of go od ongoing medical care (96% had a regular GP, 80% were prescribed inh aled steroids, 84% had a peak flow meter, GP measured peak flow routin ely in 80%, 52% had a written crisis plan and 44% had a supply of ster oids at home). However, they were severely economically disadvantaged (53% had experienced financial difficulties in the last year, and for 35% of households the only income was a social security benefit). In t he last year 39% had delayed or put off GP visit because of cost. Mana gement of the index attack was compromised by concern about medical co sts in 16% and time off work in 20%. Conclusion: Patients admitted to hospital with acute asthma have evidence of good quality on-going medi cal care, but are economically disadvantaged, If issues such as financ ial barriers to health care are not acknowledged and addressed, the he alth care son ices for asthmatics will not be effectively utilised and the current reductions in morbidity and mortality may not be maintain ed.