Urban and rural differences in the management of asthma amongst primary care physicians in Alberta.

BACKGROUND: Inconsistencies in rural and urban health care exist; however, little has been done to evaluate the potential differences in asthma management.

OBJECTIVE: To compare asthma management in rural versus urban primary care physician practices.

METHODS: Forty-two of 136 consenting primary care physicians were randomly selected for chart review. The charts of 3072 patients diagnosed with asthma based on the ICD-9 Classification of Diseases were reviewed.

RESULTS: Standards of asthma care were compared between rural and urban primary care physicians. 2671 patients (87%) were cared for by urban physicians and 401 patients (13%) by rural physicians. Greater proportions of male and pediatric patients were found in the rural group. Rural patients made more emergency department or hospital visits than urban patients. Rural physicians performed more pulmonary function tests and made more referrals to other healthcare specialists. Urban patients had more asthma symptoms and triggers documented and used peak flow monitoring more often. Urban physicians provided more asthma education and prescribed more oral corticosteroids and antibiotics. Overall, rates of referral, use of spirometry and use of written action plans were low globally.

CONCLUSIONS: Our study indicates that the management of asthma in the rural settings is comparable to that of urban settings. Improvements in the areas of pulmonary function testing, asthma education and use of written action plans are necessary in both settings.