Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
Department of Family Medicine, University of Calgary, Calgary, AB, Canada.
NPJ Prim Care Respir Med. 2020 Jun 5;30(1):24. doi: 10.1038/s41533-020-0181-3.
Although asthma is one of the most common chronic conditions affecting Canadians, its epidemiologic characteristics and burden in primary care contexts are poorly understood. The aim of this study was to develop and validate a case definition to identify adults with asthma who consult family physicians and to estimate the prevalence of asthma in that setting in Canada. This validation study utilized a database of electronic medical records (EMRs) from the Southern Alberta Primary Care Research Network, a node of the Canadian Primary Care Sentinel Surveillance Network (SAPCReN-CPCSSN). The population included patients over age 17y of any gender and health status who had visited an SAPCReN-CPCSSN primary care provider during the period December 1, 2014-December 31, 2016. The validation of the case definition involved comparing a case-finding algorithm to caseness determined by an expert physician review of the records of 1000 patient in the CPCSSN database. The case definition, which included the ICD-9 code 493 and asthma-related text words, had 83.33% sensitivity (95% CI: 63.61-93.88%), 99.28% specificity (95% CI: 98.51-99.67%), a positive predictive value of 74.07% (95% CI: 55.03-87.14%), and a negative predictive value of 99.59% (95% CI: 98.93-99.86%). The prevalence of adult asthma in CPCSSN primary care practices in southern Alberta was 4.20% (95% CI: 4.09-4.31). The strong validation metrics suggest that this case definition is valid for both clinical and research purposes. The validated case definition may be used to improve patient care and improve understanding of the prevalence and burden of asthma in primary care in Canada.
尽管哮喘是加拿大最常见的慢性疾病之一，但人们对其在初级保健环境中的流行病学特征和负担知之甚少。本研究旨在制定和验证一种病例定义，以识别在家庭医生处就诊的哮喘成人，并估计加拿大该环境中的哮喘患病率。这项验证研究利用了加拿大初级保健监测网络（SAPCReN-CPCSSN）的南阿尔伯塔初级保健研究网络的电子病历（EMR）数据库。该人群包括在 2014 年 12 月 1 日至 2016 年 12 月 31 日期间就诊于 SAPCReN-CPCSSN 初级保健提供者的任何性别和健康状况的 17 岁以上患者。该病例定义的验证包括将病例发现算法与通过对 CPCSSN 数据库中 1000 名患者的记录进行专家医生审查确定的病例进行比较。该病例定义包括 ICD-9 代码 493 和与哮喘相关的文本词，其灵敏度为 83.33%（95%CI：63.61-93.88%），特异性为 99.28%（95%CI：98.51-99.67%），阳性预测值为 74.07%（95%CI：55.03-87.14%），阴性预测值为 99.59%（95%CI：98.93-99.86%）。在南阿尔伯塔的 CPCSSN 初级保健实践中，成人哮喘的患病率为 4.20%（95%CI：4.09-4.31%）。强大的验证指标表明，该病例定义在临床和研究目的上均有效。经验证的病例定义可用于改善患者护理，并提高对加拿大初级保健中哮喘的患病率和负担的理解。
