Abstract
Background:
Guidelines are intended to optimise the quality of patient care. While optimal therapy focuses on the patient, traditionally, assessment guidelines' effectiveness has focused on physicians. Little attention has been given to the effect of guidelines on patient outcomes such as mortality, morbidity or quality of life (QOL). In this study we compare QOL in asthma patients treated according to the 1997 NIH asthma guideline and those receiving non-guideline recommended treatment.
Methods:
We determined the asthma severity of 146 asthmatics during a clinical research appointment using a combination of symptom, lung function and medication use data. The appropriateness of each patient's medication regime was determined according to the NIH asthma guideline. QOL was assessed on a 7-point scale using the validated Asthma Quality of Life questionnaire (AQLQ).
Results:
Patients treated according to the guideline had a higher QOL than patients with non-guideline treatment (5.7 vs. 5.3, p=0.019). After stratifying for asthma severity, a large clinically relevant difference in QOL (1.0) was observed for severity class 4 patients. Non-guideline treatment increased with asthma severity.
Discussion:
We observed an association between non-guideline treatment and a lower QOL, particularly in the patients with severe asthma. QOL in severe patients was lower and these patients were less likely to be treated according to the guidelines than patients with mild or moderate asthma. Further studies are needed, especially among severe asthmatics, to determine if guideline recommended treatment is responsible for the observed increase in asthma related QOL observed in this work. For doctors, and other health care professionals this study emphasises the role of evidence-based guidelines in daily practice.
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Pont, L., van der Molen, T., van der Werf, G. et al. Guideline adherence for the treatment of asthma in general practice is associated with a higher quality of life. Prim Care Respir J 11, 70 (2002). https://doi.org/10.1038/pcrj.2002.63
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DOI: https://doi.org/10.1038/pcrj.2002.63