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Practice Enhancement Program

GUIDELINES FOR CHART REVIEW

Name of Physician Assessed:

Phys I.D. _______

Name of Assessor:

Date of Assessment:

ASTHMA

Diagnosis

1. Has asthma been supported by objective lung function tests?

q

YES

q

NO

2. Has physician considered differential diagnosis? (is it asthma?

q

YES

q

NO

Monitoring

3. Does the physician use objective measures for asthma control?

q

YES

q

NO

e.g. pulmonary function testing or 30 second asthma test

4. Does the physician assess the severity of the asthma?

q

YES

q

NO

Management

5. Has the physician obtained objective evidence of allergies?

q

YES

q

NO

6. Has the physician discussed with the patient …

a) possible asthma triggers ?

q

YES

q

NO

b)

lifestyle and work issues ?

q

YES

q

NO

c) inhaler technique?

q

YES

q

NO

d) regime adherence ?

q

YES

q

NO

e) aims for asthma control?

q

YES

q

NO

o

No night time awakenings

o

Three or fewer days with symptoms and doses of rescue medication/week

o

No negative effect on normal activity, exercise, function or quality of life.

7. Are medications appropriate to symptomatology?

q

YES

q

NO

e.g. Mild Asthma Occasional use of short acting B2 agonists or

low dose inhaled steroids

Moderate Asthma Regular use of low dose corticosteroids

with addition as necessary of

Mid-dose inhaled corticosteroids

Long acting B2 agonists

or Leukotriene receptor antagonists

Severe Asthma Short acting inhaled B2 agonists

plus High dose inhaled corticosteroids

plus Long acting B2 agonists

or Leukotriene receptor antagonists.

8. Are specialist referrals made for patients who are inadequately controlled?

q

YES

q

NO

Source: Canadian Asthma Guidelines 1999 with assistance from Dr D. Cockcroft

Developed and reviewed by the Practice Enhancement Program March 2010

6.c Chart Review Checklist - CR-1