Table 4.
Predictors of controller medication initiation or escalation*
| Controller not initiated or escalated (n=4021 visits) |
Controller initiated or escalated (n=138 visits) |
P value† | OR† (95% CI) | |
| Primary care clinic, n (%) | <0.01 | |||
| Site 1 | 1781 (97.8) | 40 (2.2) | ||
| Site 2 | 869 (98.3) | 15 (1.7) | 0.68 (0.41 to 1.14) | |
| Site 3 | 1371 (94.3) | 83 (5.7) | 1.61 (1.05 to 2.48) | |
| Appointment provider type, n (%) | 0.72 | |||
| Physician | 1845 (96.6) | 65 (3.4) | ||
| Nurse practitioner | 419 (95.0) | 22 (5.0) | 0.92 (0.51 to 1.65) | |
| Resident | 1512 (97.5) | 39 (2.5) | 0.81 (0.49 to 1.35) | |
| Physician assistant | 245 (95.3) | 12 (4.7) | 0.68 (0.33 to 1.42) | |
| Clinical diagnosis of asthma, n (%) | 0.47 | |||
| Yes | 2369 (96.3) | 92 (3.7) | ||
| No | 1652 (97.3) | 46 (2.7) | 0.88 (0.62,1.25) | |
| Objective diagnosis of asthma, n (%) | 0.025 | |||
| Yes | 383 (98.7) | 5 (1.3) | ||
| No | 3638 (96.5) | 133 (3.5) | 2.44 (1.12 to 5.26) | |
| Presenting symptom, n (%) | <0.01‡ | |||
| Non-respiratory symptom | 3503 (98.5) | 52 (1.5) | ||
| Asthma | 124 (79.0) | 33 (21.0) | 17.8 (11.3 to 28.0) | |
| Other respiratory symptom | 394 (88.1) | 53 (11.9) | 7.67 (5.73 to 11.2) | |
| Time of visit, n (%) | 0.66 | |||
| On hours | 3586 (97.0) | 112 (3.0) | ||
| Weekend/after-hours | 435 (94.4) | 26 (5.6) | 1.11 (0.69 to 1.80) | |
| Previous ED visit/hospitalisation for asthma, n (%) | 0.86 | |||
| Yes | 60 (95.2) | 3 (4.8) | ||
| No | 3961 (96.7) | 135 (3.3) | 1.11 (0.37 to 3.33) | |
| Patient seen by MRP, n (%) | 0.17 | |||
| Yes | 1273 (96.8) | 42 (3.2) | ||
| No | 2748 (96.6) | 96 (3.4) | 1.43 (0.86 to 2.38) | |
| Asthma control level, n (%) | N/A§ | |||
| Uncontrolled | 636 (93.9) | 41 (6.1) | ||
| Unknown or controlled | 3385 (97.2) | 97 (2.8) |
*In measuring controller escalation/initiation, we eliminated visits in which patients had a controller medication escalated within the last 3 months (the typical duration of a therapeutic trial).56 Initiation included starting of any of the following medications: ICS alone, ICS with LABA, LABA alone, LTRA, LAAC. Escalation included an increase in the dose of an ICS or a combination ICS/LABA, addition of a LABA to an ICS, addition of an LTRA to an ICS or ICS/LABA, or addition of a LAAC to an ICS, ICS/LABA or LTRA.
†P values and ORs for each variable shown are from the multivariable model.
‡In pairwise comparisons, controller medications were initiated/escalated more often in asthma-related visits than in non-respiratory visits (OR 17.8, 95% CI 11.3 to 27.956) and in any respiratory-related visits than in non-respiratory visits (OR 7.7, 95% CI 5.7 to 11.159).
§This covariate was removed from the multivariable model since there were no subjects that had controlled asthma who had a controller initiated or escalated; the univariate p value was <0.01.
ED, emergency department; ICS, inhaled corticosteroid; LAAC, long-acting anticholinergic; LABA, long-acting beta-agonist; LTRA, leukotriene receptor antagonist; MRP, most responsible physician.