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Background: Asthma is one of the commonest public health problems in Poland and the commonest chronic disorder in children. Lodz Regional Health Insurance Fund was a sponsor of the Prevention Asthma Program in 2000–03, directed at increasing early detection and providing optimal treatment of allergies by specialists in children.
Methods: All funds were divided between 127 primary and 12 specialized care centres participated in the programme. Primary care centre goals were: anamnestic information, mapping of allergy-causing factors, repeated auscultation of the lungs, bronchial dilation test, peak expiratory flow (PEF) measurement at the clinic and at home for 2 weeks. After preliminary diagnosis patients have been send to specialized centres. Specialized care centre goals were as follows: skin testing, spirometry, repeated bronchial dilation test, determination of eosinophilic white blood cells and eosinophil cationic protein (ECP) in blood.
Results: Increasing trend of new asthma diagnosis, expressed per 1000 inhabitants, was observed from 0.99 in 2000 to 2.19 in 2003. In the first year of Asthma Prevention Program, we observed more hospital episodes because of asthma exacerbation in comparison with year 1999 but from the second year of programme we showed systematically decreasing number of hospital episodes as a result of asthma exacerbation from 1.48 in 2000 to 0.84 in 2003. We found significantly decreasing trend in duration of hospitalization due to asthma exacerbation (P = 0.001).
Conclusions: Effects of this programmes are: early identification of allergic diseases, mainly asthma, reduced number and shorter duration of hospitalization because of asthma exacerbation and establishing new Asthma Schools Education.
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Asthma prevalence in low-income communities continues to be inordinately high with 20% or more of children experiencing symptoms. Lodz region as any other regions in the world is not wealthy enough to provide its population with everything that the medicine could offer. The fact underpints the necessity of effective spending of the limited resources especially at the primary care level, such as health promotion and preventive services. The GINA guidelines, published in the early 1990s, have been disseminated to improve the quality of life of asthmatics and to reduce the socio-economic burden of asthma. However, the guidelines goals have far from been reached in many countries (7–9).
The Asthma Prevention Program in Lodz province was in progress from the 1 January 2000 to 31 December 2003. All of the primary health care centres (first level) and specialized clinical centres (second level) participated in this programme. To perform the tasks envisaged by the programme the total sum of 1 069 461 € was allotted. The overall annual cost of Asthma Prevention Program is shown in Table 6.
Table 6. Costs of Asthma Prevention Program provided by the Health Insurance Fund
|Total||1 069 461|
Early effects of this programme are in particular: early identification of allergic diseases, mainly asthma, the increased access to specialized medical care, reduced number and shorter duration of hospitalization because of asthma exacerbation. Establishing new Asthma Schools Education was one of the most important effect of this programme. Long-term benefits of asthma education for doctors and patients has been previously shown (10–12). Recently published French survey emphasizes the complexity of the notions of asthma control and exacerbation and provides novel informations to orient continuing education programmes (13). In other countries, similar allergy prevention programmes were performed but economical and political differences between the countries related to the way of organizing the providers’ payment are the reasons for the differences in the aims and results of these programmes. However, long-time effects of these prevention programmes are clearly visible (10, 14, 15). When asthma is well controlled, it rarely leads to hospitalization. As the result of these programmes asthma is better treated. Hill et al. (16) revealed that in a group of children losing more than 10 school days per year because of asthma symptoms, as many as 70% were not taking any drugs or taking only β-agonists. Such patients are at high risk for acute exacerbations, absence at work and school (17) as a result of asthma, hospitalization (18, 19) and even mortality (20, 21). It is generally accepted that early detection, patient education and optimal treatment are today the main strategies of asthma management.
However, there are still many difficulties in the establishing effective control over the provision of preventive allergy services. The main reasons for that are related to the problems in the evaluation of the results of the prevention and the specificity of the preventive services, related to education, advice to families, ability to convince the patients to comply with the treatment. It should be noticed that this was the first allergy prevention programme in Poland. Unfortunately, the programme was abandoned in 2003 because of the limited financial resources of the health insurance institution. It seems, although that it is only a transitional state all the more so because the legal regulations on the general insurance at the National Health Fund clearly indicate the need for prophylactic programmes, especially programmes dealing with socially significant health problems such as allergic diseases.
Because the health care system will be reformed again in 2005, it would be helpful if the contract between the National Health Fund and providers changes. Given the current epidemiological situation concerning allergic diseases, the patients’ accessibility to specialists should be increased.
The relatively short observation period and the type of data used in our programme did not allow us to estimate the cost-effectiveness of asthma treatment in Poland, which remains to be evaluated in further studies. Such effectiveness however, is certain.
We observed increasing number of participants during following years of Asthma Program in each age subgroup followed by increasing number of new asthma diagnosis. Results of our programme revealed the need of such strategies in the health care system. They should be directed at early diagnosis and better treatment of allergies before they lead to irreversible health deterioration.