Comparing the Asthma APGAR System and the Asthma Control Test™ in a Multicenter Primary Care Sample

Objective: To compare asthma control assessment using the Asthma APGAR system, a tool developed by primary care clinicians, in a multicenter primary care sample with the Asthma Control Test (ACT (TM))/Childhood Asthma Control Test (CACT (TM)), a tool developed by asthma specialists. Patients and Methods: This is a substudy of a multicenter, randomized, controlled pragmatic trial that tests the effectiveness of the Asthma APGAR system in primary care practices. As part of the study, enrolled patients completed both the ACT (TM)/CACT (TM) and the Asthma APGAR system between March 1, 2011, and December 31, 2011. Kappa and McNemar statistics were used to compare the results of questionnaires. Results: Of the 468 patients in our sample, 306 (65%) were classified as not controlled by the ACT (TM)/CACT (TM) or the Asthma APGAR system. The overall agreement was 84.4%, with a kappa value of.68 (substantial agreement) and a McNemar test P value of .35 (suggesting no significant difference in the direction of disagreement). Of those with poor control as defined by the Asthma APGAR system, 23.8% (73) had no controller medications and 76.5% (234) were seldom or sometimes able to avoid identified triggers for their asthma. Of those who stated that they had been prescribed controller medications, 116 of 332 (35%) stated that they did not use the controller medication on a daily basis. Conclusion: The Asthma APGAR system and the ACT (TM)/CACT (TM) similarly assess asthma control in a multicenter primary care-based sample. The Asthma APGAR system identified an "actionable item" in more than 75% (234) of the individuals with poor asthma control, thus linking an assessment of poor asthma control with a management strategy. (C) 2014 Mayo Foundation for Medical Education and Research