Asthma Research Unit - Research Poster

Asthma Research Unit Posters

The effect of a trained asthma nurse on patient
outcomes in general practice

Presented at the
General Practitioners in Asthma Group Conference
June 1998, in Oxford

G Hoskins, R G Neville, B Smith and R A Clark

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:

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

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

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

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 9654 patients.

Practices who had:

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 inhlaer technique

Inhaler technique and compliance

Symptoms at assessment and days off in last month

Acute attacks and short courses of systemic steroids

no nurse run asthma clinic
(7 practices, 210 [22%] patients) were associated positively with

Ownership of SMPs

Short course of systemic steroids

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

Conclusion

On the results to date there appears to be a clear associated 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.

For further information on the Asthma Research Unit, please contact:
Tayside Centre for General Practice
University of Dundee
Kirsty Semple Way
Dundee DD2 4BF
Scotland
Tel : +44 (0)1382 420000
Fax :+44 (0)1382 420010
aru@tcgp.dundee.ac.uk

Updated by Mark Stewart: Tuesday, November 6, 2001