Measuring, Monitoring and Managing Series

ATAQ--Asthma Therapy Assessment Questionnaire--The National Asthma Education and Prevention Program (NAEPP) guidelines from the 1997 National Heart Lung and Blood Institute's (NHLBI) make the point that measuring asthma control is essential when monitoring asthma or reactive airway disease, regardless if the objectives of therapy are being met. This research involved Merck's [don't try to find the questionnaire, there or at Merck-Medco, however] Asthma Therapy Assessment Questionnaire (ATAQ) that measures five asthma management domains; 1) asthma control, 2) knowledge barriers, 3) patient behavior/attitude barriers, 4) self-efficacy (patient beliefs), and 5) patient/provider communication barriers. The asthma control domain measures four indicators of control within seven of its items: 1) patient perception of control, 2) nocturnal symptoms, 3) ability to participate in normal activities, and 4) overuse or increased use of reliever medications.

The purpose of this research was to determine if levels of control as measured by ATAQ were related to levels of functional status and quality of life as measured by the SF-36 and Asthma Quality of Life (AQOL) instrument (Juniper, 1992), and self-reported health care utilization.

Study Design: N = 3,490 asthmatic managed care members (ages 18 years +) identified by using an algorithm based on filled pharmaceutical prescriptions and hospital admissions, ED visits, and urgent care use. One quarter of the adult members were randomly selected to receive a survey using the ATAQ, the SF-36 and the AQOL survey instruments. (Response rate--57.3%). The ATAQ control domain index scale ranges from no control problems = 0 to all 4 control problems = 4. "Three additional questions were contained in this version of ATAQ to assess the relationship between past resource use (self-reported unscheduled office visits, emergency department use and hospital admissions in the past 12 months) and control among asthmatic patients. The SF-36 measures quality of life in 2 broad domains; physical health and emotional health. Each domain scale ranges from 0-100, with lower numbers indicating worse quality of life. The AQOL instrument measures asthma quality of life overall, and for 4 individual domains (activities, emotions, symptoms and environmental triggers). Each AQOL domain scale ranges from one to seven, with lower numbers indicating worse quality of life."

Principal Findings: Unscheduled office visits, ED use, and hospitalizations for asthma in the past year were 52%, 23% and 6% of patients, respectively. "All 3 measures of resource use were highly significantly associated with increasing numbers of asthma control problems. As the number of problems increased, so did the percentage of patients utilizing health services. The % of patients reporting 0,1,2,3, or 4 control problems were 21%, 28%, 28% 16% and 7% respectively. In a one-way analysis of variance the SF-36 scales and the AQOL scales scores declined markedly and steadily* as the number of control problems increased. The associations between the scales in each instrument were statistically significant (p < .001)." * dropping by 0.5 or more with each increase in number of control problems. A change of this magnitude is considered to be clinically significant based on past research.

Conclusions: "The control domain index score in ATAQ is highly correlated with widely used measures of overall and asthma-specific quality of life instruments. Our results further highlight the burden of poor asthma control on patient quality of life and functional status." Poster 463. "The Impact of Asthma Control on Resource Use, Functioning and Quality of Life" by L Markson, WM Vollmer, LK Fitterman, et al (presenter and Manager, Outcomes Research and Management. Merck & Co., Inc. West Point, PA 19486-0164. Phone: 215-652-7546. Fax: 215-652-0860

The ATAQ was also performed on 4795 HMO members in another study of one year's scope. Findings: More than 50% of patients had at least one control problem, and 13.5% had three or four. Both acute and routine healthcare use increased with increasing numbers of control problems. As expected, those with three or four problems were more likely (3.5 times) than those with no problems to have an acute care episode. "There were also significant increases in the relative risk of an acute care episode among subjects with two control problems (1.7) or one control problem (1.4). Obviously, the more control problems, the greater the opportunity, for example, to review pharmacologic therapy and adherence, or to increase educational efforts regarding triggers and allergen avoidance." Am J Respir Crit Care Med. January 15, 2002;165:195-199.

In a third validation study for the ATAQ, the previously observed rate of 15% of asthmatics who used the ER or were admitted, was reduced to a 3% rate with this type of measurement, management and monitoring program. WM Volmer, LE Markson, E O.Connor, et al. "Association of Asthma Control with Health Care Utilization and Quality of Life." (Kaiser) Am. J Respir Crit Care Med. 1999;160:1647-1652. (www.atsjournals.org)

See also, the Asthma Self-Management Action (A.S.M.A.) Plan from NHLB Institute NIH Pub. #97-4053 (it employed a quadruplicate form when I last reviewed it).