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Aim
To
examine process and outcome of asthma care in relation to the availability
of specially trained asthma nurses.
Method
Data
from Tayside general practices was collated by:
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Structure:
Whether or not the practice had
- an
asthma clinic run by a nurse with an asthma diploma
- no
nurse run asthma clinic
- an
asthma clinic run by a nurse with no diploma
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Process
Details on
- Patient
and practice initiated GP and nurse consultations
- Possession
of SMPs and PEFMs
- Assessment
of peak flow, compliance and inhaler technique
- Attendance
for assessment
- Planned
follow up
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Clinical
Outcomes
Number of
- Asthma
attacks
- Rescue
courses of oral steroids
- Emergency
nebulisations
- The
presence of symptoms on assessment
- Work
or school days lost due to asthma
- Attendances
at A&E
- Attendances
at outpatients
- Hospital
admissions
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This correspondence survey was a joint initiative between the University
of Dundee and Tayside Health Board. Post Graduate Education Allowance(PGEA)
and Chronic Disease Management(CDM) were offered to participants. Practices
completed questionnaires on 30 randomly selected patients from their asthma
register. Each patients current asthma status was assessed and recorded
using the Tayside Asthma Assessment Stamp. The presence of symptoms, PEFR,
inhaler technique, compliance and the number of days off work or school
due to asthma in the previous month were noted. Follow up arrangements
were also recorded.
Results
Results
are presented on 32(41%) of Tayside general practitioners who provided
information on 954 patients.
Practices who had
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an
asthma clinic run by a nurse with a recognised asthma diploma
(11 practices, 330 [35%] patients)
were associated positively with
- Ownership
of SMPs
- Assessment
of inhaler technique
- Inhaler
technique and compliance
- Symptoms
at assessment and days off in last month
- Acute
attacks and short courses of systemic steroids
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no
nurse run asthma clinic
(7 practices, 210 [22%] patients)
were associated positively with
- Ownership
of SMPs
- Short
courses of systemic steroids
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an
asthma clinic run by a nurse with no asthma diploma
(14 practices, 414 [43%] patients)
were associated positively with
- Recording
of PEFR and assessment of inhaler technique
- Asthma
review consultations
- Patient
compliance
- Inhaler
technique
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Conclusion
On
the results to date there appears to be a clear association between structure,
process and clinical outcome. Practices with a specially trained nurse
"do better". Some practices have nurses running asthma clinics
without adequate training. There is an unmet training need for these practice
nurses.
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