|
Aim
To examine
the structure of asthma management within general practice and its effect
on the process and outcome of patient care.
Method
This involved
observations on:
| Structure: |
| Whether
of not the practice had |
- a
nurse with a recognised asthma diploma
|
- undertaken
an audit of asthma care in the past 3 years
|
- a
CDM approved asthma clinic
|
|
|
|
| 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
|
|
|
|
| Primary
care outcomes |
|
Number
of
|
|
|
- Rescue
courses of oral steroids
|
|
|
- The
presence of symptoms on assessment
|
- Work
or school days lost due to asthma
|
|
| Secondary
care outcomes |
|
Number
of
|
|
|
- Attendances
at outpatients
|
|
|
|
|
This was
a correspondence survey in which 225 general practitioners provided information
on 6732 patients. Practices completed questionnaires on 30 randomly selected
patients from the 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 due to asthma in the previous month were noted. Follow up
arrangements were also recorded.
Results
Practices
who had
An
FHSA accredited CDM clinic
(166 practices,5000 patients)
were associated with |
- more
patient and practice initiated nurse consultations
|
- process
measures for asthma reviews i.e. assessment of inhaler
technique, drug compliance, issue of SMPs and follow up
arrangements
|
- no
favourable associations with clinical outcomes in primary
of secondary care
|
- more
patients suffering an attack or lost time from work or
school
|
|
Undertaken
previous asthma audit
(143 practices,4259 patients)
were associated with |
- more
patient and practice initiated nurse consultations and
fewer GP consultations
|
- more
were in possession of a SMP and PEFM and reported fewer
days off work or school
|
- fewer
patients attended A&E or outpatient departments
|
|
A
nurse with an asthma diploma
(138 practices,4122 patients)
were associated with |
- more
patient and practice initiated nurse consultations and
fewer GP consultations
|
- fewer
consultations for respiratory infection
|
- a
favourable primary care outcome measure with fewer days
off work or school
|
- more
patients reported symptoms at time of assessment
|
|
Conclusion
Although
practices who run an FHSA approved CDM asthma clinic show associations
with favourable process of care, it is the practices who employ a nurse
with special training or undertake audit who are associated with favourable
clinical outcomes. FHSA Accreditation by a series of easily counted process
measures may not be the most suitable method for assessing general practice
achievement.
|
