Aim

To assess whether the experience of completing a health authority supported audit cycle of data recording, distance learning and receipt of patient specific feedback is associated with favourable improvement in the process and outcome of asthma care in a primary care setting

Method

All primary care physician practices from one health region were invited to participate in an audit of their practice asthma management. Post Graduate Education Allowance(PGEA) for doctors, Post registration education and practice (PREP) study hours for nurses, and regional health authority Chronic Disease Management (CDM) accreditation were offered to participants. Interested practices provided details of health service resource use for 30 randomly selected asthma patients over a retrospective 12 month period. All patients were then invited for clinical review of their current asthma status, assessed and recorded with the aid of 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. One year on practices repeated the process with the same patients.

Results

20 primary care practices from one Scottish Health Authority region worked with us to complete a two year audit cycle.

Conclusion

Any improvement in practice asthma management will have a positive effect on all asthma patients. From this study we cannot infer cause and effect, changes seen in patient outcomes might be associated with practice audit activity but not necessarily caused by it. Participation in the audit may have helped to improve process of care and reduce patient morbidity allowing us the inference of association that linking audit with a practice educational package can benefit practices and patients. Movement away from BAG treatment step one in the second year indicates that practices were heeding the message of stepping up/stepping down medication as dictated by symptoms. Although not translated into improved attack rates and significant decrease in admission to hospital, continued access to good quality audit which utilises modern technology will help to focus and educate health professionals organising asthma care. Over time this may impact on attack rates and secondary care contact. Recognition and support of good practice by health authorities will encourage participation. Utilisation of the most up to date information management technology which provides for ready access of the audit tools via the WWW will allow for expansion of and easier collection of audit data. The Scottish Asthma Management Initiative which was born out of this regional pilot will begin to address the issue of readily available quality audit.