- The Severe Asthma Index assesses how nations address severe asthma.
- Results indicate a need to recognize severe asthma as a health care priority.
- A whole-system approach is needed as well.
Individual nation results from the Severe Asthma Index indicate that the disease remains inadequately prioritized around the world, according to an abstract presented at the European Respiratory Society International Congress.
These results also highlight the need for a comprehensive, whole-system approach for improving the management and prevention of severe asthma, Patrick Henry Gallen, MSc, senior advisor and futurist at Copenhagen Institute for Futures Studies, said during the presentation.
“The Severe Asthma Index is a first-of-its-kind tool for analyzing and comparing country health systems’ approaches to managing and preventing severe asthma, as well as identifying best practices in severe asthma care,” Gallen said.
The disproportionate impact and burden of asthma in relation to the estimated percentage of patients with severe asthma worldwide drove the creation of the measure, he continued.
“While around 5% of people with asthma are diagnosed with severe asthma, severe asthma makes up around half of the total resource expenditure on asthma among health systems worldwide,” Gallen said.
Also, mortality rates for severe asthma are nearly double those of the rates for all people with asthma, with greater frequencies of life-threatening exacerbations, negative impacts on quality of life and impairments in mental and social health, he said.
“Given the disproportionate impact of severe asthma, we see a growing imperative for policymakers, clinicians, and patient and civil society organizations to develop a more comprehensive and robust understanding of how health systems manage the disease and to identify best practices that may prevent disease progression and improve asthma control,” Gallen said.
The Severe Asthma Index
Using multiple sources of quantitative and qualitative data from 29 countries in the Organization for Economic Co-operation and Development (OECD), the Severe Asthma Index assesses national health system approaches and other related factors in managing severe asthma.
The index aims to illuminate best practices by providing freely available knowledge for use by public or private entities, drive informed discussion by supporting policy initiatives and advocacy that improve access to care, and advocate for national plans by driving the creation of national action plans for severe asthma.
In the form of country scores, the index analysis provides comparative insights between countries and country-specific overviews that can help stakeholders achieve major outcomes, Cullen said. These outcomes may include:
- ensuring the implementation of coherent, long-term strategies and guidelines for severe asthma;
- emphasizing the role of prevention and early intervention in severe asthma care;
- implementing standardized reporting protocols and improved access to data related to severe asthma; and
- empowering patients and educating the public about the impact of severe asthma.
The index assesses 28 indicators that impact the ability of country health systems to manage and prevent severe asthma across five thematic categories, including environmental factors (10%), disease burden (15%), health system characteristics (20%), access and care coverage (25%), and policy context (30%).
A range of quantitative and qualitative data points collected from national and international databases operationalized these indicators, Gallen said. Also, questionnaire responses from more than 70 experts representing relevant national health authorities supplemented the data collection. Scorecards quantified qualitative data, and final index scores were normalized on a scale from 0 to 10.
“Scores closer to zero indicate a low level of fulfillment of predefined criteria, such as the existence and level of implementation of national guidelines for severe asthma care, whereas scores closer to 10 indicate a higher level of fulfillment of predefined criteria,” Gallen said.
These scores do not reflect a normative evaluation of the quality of severe asthma practices, Gallen clarified. Instead, they represent a goodness of fit to the ideal assessment framework model.
Overall country scores were calculated with the weighted average across all five indicators, which were weighted to emphasize factors over which health care decision-makers and policymakers have more direct influence, and then multiplied by 10 to increase their granularity.
The overall average index score for all countries was 62. Australia was first with 73.2, followed by France, New Zealand, Italy and the United Kingdom. Latvia had the lowest index score. The United States was not included in the analysis.
Recommended improvements, conclusions
Based on the thematic categories that the index used, the researchers recommended improvements in indoor and outdoor air quality, behavioral factors that impact asthma severity, data collection and coding, and health care system structures and systemic inequalities. Also, the researchers recommended the definition and implementation of severe asthma strategies.
Gallen also said that the index supports several conclusions.
“Firstly, severe asthma should be recognized as a health care priority, and key stakeholders should actively prioritize severe asthma as a disease with high individual and societal costs,” he said.
The researchers also said that there is a lack of dedicated asthma strategies.
“Strong and comprehensive policies and guidelines are therefore needed to improve severe asthma care,” Gallen said.
Third, there is great variation in asthma reporting between countries, with vast differences creating difficulties in ascertaining the full impact of severe asthma.
“Access to care also varies significantly across countries,” Gallen said.
Equity should be a focus, as care pathways and reimbursement policies are critical for experience and outcomes in severe asthma care, he continued.
Additionally, the researchers concluded that a focus on behavior and lifestyle factors such as obesity and smoking may have a significant impact on asthma outcomes.
Lastly, Gallen said, many systemic, policy and environmental factors impact patient outcomes and experiences as well.
“A whole-system approach to manage severe asthma is needed,” he said.