Asthma is among the conditions most often targeted by behavioral interventions, including self-management. The Singapore National Asthma Program (SNAP) was launched in 2001 to address the high burden of asthma in Singapore. One component of the SNAP was improving asthma control in the community by promoting preventive treatment with inhaled corticosteroids. Chong and coworkers described the program on prescription patterns of preventor and reliever medication for asthma in the clinics of the city. The investigators monitored the prescription pattern for asthma as the preventor-reliever (PR) drug ratio. The PR ratio was employed both as a positive feedback tool and as a key performance indicator for the program. Individual clinics were encouraged to implement locally relevant and effective initiatives to increase the performance indicator and facilitate this process. A number of intervention methods were used. In the course of the program, the case load for asthma in the clinics increased by 31%. During the same period, the average PR ratio increased significantly from 0.68 to 1.80.

WHAT THE STUDY MAY MEAN TO THE READER: The authors concluded that a simple audit and positive feedback program based on PR ratios were associated with a significant shift in the drug treatment of asthma away from quick relief medication towards long-term daily preventive treatment. The weakness of the study was that so many separate interventions were introduced that it is impossible to know what led to the change. Still, whatever was used worked in a positive way.

PN Chong et al. Impact of the Singapore National Asthma Program (SNAP) on Preventor-Reliever Prescription Ratio in Polyclinics. Annals of the Academy of Medicine, Singapore, 2008;37:114-124.