Receipt of asthma self-management education in adults with asthma

Asthma management guidelines include the delivery of asthma management plans to all adults with asthma. Our objective was to investigate the disparities in receipt of asthma management plans in a population-based sample of adults with asthma. We examined data from 3,756 adults (weighted n = 30,696,018) with self-reported current asthma by pooling cross sectional data from years 2003 and 2008 of the National Health Interview Survey an annual cross-sectional survey that provides health-related estimates of the population of the United States. We defined having received an asthma management plan as answering ‘yes' to the question ‘Has a doctor or other health professional ever given you an asthma management plan or an asthma action plan?' We used multivariable logistic regression to model odds of receipt of asthma management by sociodemographic characteristics, health insurance status, usual source of care, asthma-related emergency department use, asthma-related hospitalizations, use of quick relief inhaler, use of preventative medication, smoking status, and survey year. Adjusted odds ratios (OR) and 95% CI (CI) are reported. The percentage of adults who reported receiving asthma management plans was 32.8% in 2003 and 29.4% in 2008. Non-Hispanic Blacks were more likely to receive an asthma management plan (OR 1.4; CI 1.1-1.7) and Hispanics were less likely to receive an asthma management plan (OR 0.8; CI 0.6-1.0) compared to Non-Hispanic Whites. Individuals with less than high school (OR 0.7; CI 0.5-1.0) and high school (OR 0.8; CI 0.7-0.9) levels of educational attainment were less likely to receive plans compared to individuals with post-college levels of educational attainment. Individuals who currently used quick relief inhalers (OR 2.4; CI 1.4-4.3) or preventative medication (OR 4.0; CI 2.8-5.7) were more likely to receive a plan compared to those who did not. Compared to those who did not have an asthma attack in the past 12 months,those who did and sought treatment in the emergency room (OR 0.8; CI 0.4-1.5) or were hospitalized (OR 1.4; CI 0.9-2.2) were not more likely to receive an asthma management plan. There remain important disparities in receipt of asthma management plans. There may be missed opportunities for provision of asthma self-management education in the emergency room and during patient hospitalizations. Future research needs to address practices that will increase delivery of asthma management plans to all adults with asthma.