Welcome to the Primary Care Asthma Program

 

Background

The Primary Care Asthma Program (PCAP) is an evidence-based asthma program intended to provide primary care providers with decision aids to support best practice regarding asthma assessment, diagnosis and management. Its development, implementation and evaluation as a pilot program were funded through the Ontario Ministry of Health and Long-Term Care, as one of the initiatives of the Asthma Plan of Action. The pilot for this program was evaluated through a research study led by Drs. Teresa To and Lisa Cicutto in 8 primary care sites across the province from 2002-2006.
Results of the pilot were very positive for asthma management, patient outcomes and acute care use and were sustained at 6 and 12 month intervals. There were statistically significant improvements in:

    • the amount of spirometry done almost doubled to 67.4% from 38.4% (p<0.0001)
    • relative reduction of 33.7%  in  daytime asthma symptoms  (p=0.0432)
    • relative reduction of 45.2%  in night time awakening symptoms (p<0.0001)
    • relative reduction of 29.9%  in asthma attacks (p<0.0001)
    • relative reduction of 48.8 %  in missed school days (p=0.0004)
    • relative reduction of 50.0% in emergency department visits (p<0.0001).1

The PCAP tools are intended for use by a multi-disciplinary team and include:

The PCAP tools are based on current Canadian Asthma Consensus Guidelines and were revised in 2006, utilizing the results of the pilot program and stakeholder feedback. The care map and action plan are being adapted for integration into electronic medical records (EMRs) in primary care.


The Primary Care Asthma Program is delivered within a multi disciplinary team of primary care providers with the leadership of a Site Coordinator and/or a Certified Asthma Educator. The Site Coordinator and/or a Certified Asthma Educator assist with program implementation, mentoring, education of patients and staff. Key to the success of this program is the expertise of the educator who provides current evidence-based knowledge and assists with on-site objective measurements via spirometry to facilitate accurate diagnosis and management of asthma. The program is modeled on fostering patient and family self-management.


A Provincial PCAP Coordinator was added in 2007 to support the sites with materials and processes to address ongoing program issues and to assist new sites, primarily Family Health Teams, with implementation of PCAP. A strategic planning session was held in the fall of 2007, with key strategies including definition of the governance structure, development of a generic business case and marketing plan, and standardization of the program including a teaching plan, implementation guide and reference manual. Working groups assist with recommendations related to issues identified by the Advisory.


PCAP is part of Ontario’s Asthma Plan of Action (APA), an integrated strategy of thirteen initiatives based on the Canadian Asthma Consensus Guidelines 2,3,  and the Canadian Thoracic Society Guidelines for occupational asthma4.  The goal of the APA is to reduce mortality, morbidity and health care costs for children and adults with asthma through an integrated plan focused on health promotion and prevention, management and treatment and research and surveillance.

 1 T. To, L. Cicutto, N. Degani, S. McLimont, J. Beyene,  Can a Community  Evidence-based Asthma Care Program Improve Clinical Outcomes? A Longitudinal Study.  Med Care 2008;46: 1257-1266

 2 Boulet, L.-P., A. Becker, D. Bérubé, R. Beveridge, and P. Ernst, on behalf of the Canadian Asthma Consensus Group. 1999. Canadian asthma consensus report. CMAJ 161 (11 Suppl.): S1-61.
3 Boulet L.-P., T. R. Bai, A. Becker, D. Bérubé, R. Beveridge, D. M. Bowie, K. R. Chapman, et. al. 2001. What is new since the last (1999) Canadian Asthma Consensus Guidelines? Can Respir J 8 (Suppl A): 5A-27A.
4 Tarlo, S. M., L.-P. Boulet, A. Cartier, D. Cockcroft, J. Côté, F. E. Hargreave, L. Holness, G. Liss, J. L. Malo, and M. Chan-Yeung. Canadian Thoracic Society Guidelines for occupational asthma. 1998. Can Respir J 5 (4): 289-300.

 
 

Primary Care Asthma Pilot Project (PCAPP) Sites and current Primary Care Asthma Program (PCAP) Sites

The eight sites that participated in the Primary Care Asthma Pilot Project (PCAPP) include:

Four sites were added when the pilot project was completed:

Notes:  

Post pilot project, the Firestone Institute for Respiratory Health and the Kingston General Hospital took on the coordinating role for PCAP services in the Hamiton and Kingston areas respectively.