Evaluation of a Workplace Asthma Self-Management

ProgramNeil J. MacKinnon, Ph.D., FCSHP

Associate Professor & Associate Director for Research

Dalhousie University College of PharmacyHalifax, Nova Scotia

What is Inspire at Work?

Medavie Blue Cross, a benefits carrier, partnered with 7 employers in the province of New Brunswick, GlaxoSmithKline and Dalhousie University.

Information sessions were held in workplaces to recruit participants; participation was voluntary.

Two pre-scheduled private educational sessions were held with a certified asthma educator at 3 month intervals (60 – 90 minutes).

The asthma educator performed an asthma assessment and spirometry testing, assessed puffer technique and developed an asthma action plan with the patient.

6 & 9 months follow-up assessments were conducted.

The Participants

73.7%

20.2%

5.1%

1%

Employees (73)

Spouses (5)

Dependents (20)

Other (1)

•69.7% Female•30.3% Male

•Average Age 39yrs

105 Participants enrolled in the study with 99 completing it (5.7% drop-out)

Breakdown by Participant Type:

In total, the asthma educator identified 188 problems related to asthma care in these 99 patients, an average of 1.90 problems per patient. Potential Drug-Related Problems (pDRPs) – 53 identifiedNon Drug-Related Problems (nDRPs) – 89 identifiedDrug-Related Problems (DRPs) – 46 identifiedPublished in the March/April issue of CPJ

Asthma-Related Problems Identified

Economic Outcomes – Medication Claims data analysis

Percent Changes: Pre vs. Post

Asthma Drugs

Antibiotics

Inspire at Work Participants

39.10% 23.10%

Everyone BUT Inspire at Work

17.60% 0.00%

The change in asthma drug claims is not surprising given the types of DRPs the Asthma Educator found:

Need additional therapyNeed higher dosageNon-compliance

27.7

98.0

0

50

100

Baseline

3 months

2.853.97

0

2

4

Baseline

3 months

Percentage of patients with a score of 4 (S)

Average Score (S)

Inhaler Technique:

Medication Adherence/Usage

0.860.15

0

0.5

1

Baseline

9 months

Self-reported paid work days lost over past 3 months by employee participants (NS)

Self-reported school days lost over past 3 months by child/dependent participants (S)

1.16

00

0.5

1

1.5

Baseline

9 months

Economic Outcomes - Absenteeism

85.4

95.9

80

90

100

Baseline

9 months

88.6

96.0

80

90

100

Baseline

9 months

Percentage of time you are able to be as productive as normal while bothered by asthma? (S)Percentage of work accomplished while bothered by asthma? (S)

Economic Outcomes - Productivity

During the past 3 months, how many days did you experience asthma symptoms at work? (S)

5.3 1.8

0

2

4

6

Baseline

9 months

Overall, Inspire at Work appears to have had a positive impact on workplace productivity.

Costs associated with delivering the program:• Asthma Educator’s time & travel costs,

marketing material, delivery support, data entry, employee time, supplies

Savings realized through:• Increased Productivity (reduced

absenteeism and reduced presenteeism)

$4.24 return on every dollar spent towards the program

Return on Investment (ROI)

Overall, Inspire at Work had a positive impact on asthma symptoms

35.261.6

0

50

100

Baseline

9 months

For someone to ‘pass’ the 30 Second Asthma Test, they must answer ‘no’ to all 5 of the following questions:

The percentage of patients who answered ‘no’ to all 5 questions. (S)

Do you use your blue inhaler 4 or more times per week?

Do you cough, wheeze or have a tight chest because of your asthma?

Do coughing, wheezing or chest tightness wake you at night?

Do you stop exercising because of your asthma? Do you ever miss work or school because of

your asthma?

30 Second Asthma Test

The questionnaire featured 24 questions which addressed many asthma-specific QoL issues.

Sample questions: Does your asthma limit you in these activities over

the last 3 months? Climbing one flight of stairs

Did you limit the kind of work or other activities that you did?

For every question in the Quality of Life (QoL) survey, there was a statistically significant improvement in scores across the 4 times points.

Humanistic Outcomes: Quality of Life

Conclusions

Increasing healthcare costs are causing employers and benefits carriers in Canada to think of innovative solutions to this issue.

Inspire at Work, while increasing asthma drug costs, had a favourable ROI and positively impacted clinical and humanistic outcomes.