| Previous
projects
-
- Computerised
Decision Support for Asthma in General Practice
- Identifying
Patients at Risk of an Asthma Exacerbation
- Clinician-Led
WWW Respiratory Site
- National
Audit of Acute Asthma Attacks
- Tayside
Childhood Asthma Project
- National
Asthma Management Study
- Asthma
and Growth in Tayside Children
- Economic
Evaluation of Acute Asthma Attack
Current
Projects
- 1.
A Qualitative Investigation of treatment goals. Asthma Severity
and Deprivation
This
project has been funded by the NHS R&D to do a qualitative study
of patient's treatment goals in asthma. The study, based in
the Asthma Group, will develop the knowledge of the patient's perspective
of asthma treatments and outcomes. This accords with the Asthma
Group's previous work on enhancing health professional-patient communication
and developing a partnership in care. It is envisaged that in
future studies patient goals will be incorporated in asthma management
plans.
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- 2.
Scottish Asthma Management Initiative (SAMI)
This Scottish Office initiative gives GPs in all regions of Scotland
the chance to work with the Unit to improve the care of patients with
asthma. The initiative, piloted in Tayside and Fife, comprises
a data recording booklet linked to an educational programme. The
interactive and personalised feedback aims to reduce patient morbidity,
including hospital admissions.
-
Hoskins
G, Smith B, Neville RG, Clark RA. The Tayside Asthma Management
Initiative. Health Bulletin 56(2) March 1998
-
Initial
SAMI Flyer
-
Information
on the Study
-
Research
Posters
-
1.
Frequency of Symptoms in Patients Attending for Asthma Assessment
in UK General Practices
- Presented at ATS Conference, San Diego, Apr 99.
2. Asthma Management Initiative
in Scotland
- Presented at ATS Conference, San Diego, Apr 99.
3. The effect of a trained asthma
nurse on patient outcomes in general practice
- Presented at the GPIAG Conference Oxford, Jun 98
4. Structure, Process and Outcome of Asthma
Clinics.
- Presented at CRAG Conference, Edinburgh, Dec 97
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3. General
Practitioners in Asthma Group Internet Service
-
The
unit has ties with the WWW site
for the GPIAG, a group of UK wide GPs who share a common interest
in asthma. We also provide Internet access to all GPIAG members allowing
them to surf the web and send and receive e-mail. This project is
funded by Allen & Hanburys Ltd.
-
Ricketts
IW, McCowan C, Neville RG, Warner FC, Cairns AY, Cobley AC. Connecting
the GPIAG - One years experience. Mednet 97 1997 ISSN 1350-3162
PS10 42
-
Research
Posters
-
1.
Connecting the GPIAG One Year's Experience
- Presented at the MEDNET 97 Conference held in Brighton, Nov 97
-
2.
GPIAG Internet Service - Two years On
- Presented at the NAC Conference London, Feb 98
- 3.
What Methods of Communication Do GPs Prefer to Use
- Presented at the GPIAG Conference Oxford, Jun 98
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- 4. Web
Builder
-
User
friendly software is being developed as part of a project involving
Tayside Health Board (FINIX), Tayside Centre for General Practice
and the Department of Applied Computing. This sofware will use
an easy-to-use data-entry interface to capture the information from
each Practice and will generate complete web sites from the information
that the practices provide.
-
'Interested'
click for more information
-
Research
Poster
-
"Web
Doctor" - WWWeb Page Designing Software for General Practices.
- Presented at BCS Medical Scotland, Jun 98
-
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-
7. E-MAIL
CONSULTATIONS IN GENERAL PRACTICE
- This project
developed and evaluated an e-mail service enabling communication between
patients and their general practice regarding repeat prescriptions,
appointment booking and clinical enquiries. The service was developed
in an urban practice within Dundee in early 2003 and evaluated after
six months. There were 150 patients recruited to the service and satisfaction
with the service was very high. Patients specifically commended the
practice for setting up a facility to allow communication out with standard
working hours and for the ease of ordering repeat prescriptions. Patients
were pleased to have a means of seeking their doctor’s comment
or opinion without bothering him or her by making and attending a formal
face to face consultation.
-
- * Full
Research Paper - PDF document
* Project Report - PDF document
- Return
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Past Projects
- 1. Computerised
Decision Support for Asthma in General Practice
- This project
(funded by the Scottish Home and Health Dept., Scottish Office) produced
a computer-based decision support program for use during asthma consultations
in General Practice. Clinicians were issued with management advice related
to current concensus treatment guidelines dependant on the consulting
patient's circumstances.
-
The
difficulties faced by the researchers included first developing a
working program which was both easy to use but fast and accurate,
and secondly the task of persuading GPs to use a computer to aid with
consultations. Many people saw the medical consultation as one of
the few areas computers had not penetrated and our task was to produce
a project to persuade GPs that there was a place for the computer.
-
McCowan
C, Neville RG, Cairns AY, Ricketts IW, Warner FC, Clark RA, Thomas
GE. Computer-assisted assessment and management of patients with
asthma - a preliminary report. Conference proceedings of Healthcare
Computing 1997 Part 1 BJHC Limited, Surrey ISBN 0948198265 117-121.
-
Research
Poster
- Computer
Assisted Assessment and Management of patients with Asthma.
- Presented at the Healthcare Computing Conference, Harrogate,
Mar 97.
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- 2. Identifying
Patients at Risk of an Asthma Exacerbation
-
Using
an existing database of 12,203 patients this project, funded by Zeneca,
aimed to identify the characteristics of patients who might benefit
from a change in therapy and what the health economics of such a change
might be. This database included details on health service utilisation,
prescriptions, BTS guideline therapy 'steps', and symptoms on recent
clinical assessment.
-
Research
Posters:
-
1.
Identifying Patients "At Risks" of an Exacerbation of Asthma.
G Hoskins, C McCowan, G E Thomas, R G Neville, B Smith, S Silverman
- Presented at the European Respiratory Society Conference Geneva,
Sep 98.
-
2.
Asthma in the Elderly - Are We Getting it Right?
G Hoskins, C McCowan, G E Thomas, B Smith, R G Neville and R A Clark
- Presented at the World Asthma Conference Barcelona, Dec 98.
-
3.
Symptoms, Treatment Step and Admission Rates in 12,203 UK Asthmatics.
Neville R G, McCowan C, Hoskins G, Thomas G E - Presented at
the World Asthma Conference Barcelona, Dec 98.
-
4.
The Economic Implications of an Asthma Attack. G Hoskins, B
Smith, C Thomson, M Sculpher, C McCowan and R G Neville - Presented
at the European Respiratory Society Conference Berlin, Sep 97.
-
5.
Counting the Costs of Poorly Controlled Asthma in the Community.
G Hoskins, C McCowan, R G Neville, B Smith, G E Thomas, S Silverman.
Presented at the American Thoracic Society Conference San Diego, Apr
99.
- 6.
Assessing the Management and Associated Costs of Paediatric Asthma
in the Community. National Asthma Campaign Conference London,
Jun 99. G Hoskins, C McCowan, R G Neville, B Smith, G E Thomas,
S Silverman.
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3.
Clinician-led WWW Respiratory Site
-
A
Scottish Office funded two year project the aims of which were: to
provide a novel service giving GPs in Scotland desktop access to computerised
decision support software for the management of asthma; to establish
a methodology for the development of internet based add-ons for GPASS
and other general practice or hospital computer systems; to promote
the use of the SIGN guidelines for Asthma in general practice.
The project was a good example of research theory being used in practice;
the respiratory WWW site would become a focus for disseminating information
by Scottish Office, GPASS and other groups.
- Why not
visit the new site: http://www.srs.org.uk/
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4. National
Audit of Acute Asthma Attacks
- In 1991/92
218 general practitioners participated in a postal survey recording
details of 1,805 patients who had suffered an asthma attack within a
specific three month period. This UK wide survey of the management of
asthma attacks within general practice, funded by the GP's in Asthma
Group, highlighted the gap between recommended and actual management.
The underuse of systemic steroids and nebulised bronchodilators in attacks
of all degrees of severity was of particular concern. With the publication
of revised guidelines in 1993 there was an opportunity to repeat the
audit and assess any change in line with guidelines. For the second
survey 299 GPs recorded details of 2,332 patients. Although an improvement
was recorded with more use of systemic steroids being used and step
up in preventative therapy more practised, it still fell short of recommended
management. Work to encourage best possible practice continues.
- Neville
RG, Clark RA, Hoskins G, Smith B for General Practitioners in Asthma
Group. National Asthma Attack Audit 1991-92. BMJ 1993 306 559-62
- Neville
RG, Hoskins G, Smith B, Clark RA. How General Practitioners Manage
Acute Asthma Attacks. Thorax 1997 52: (2) 153-156
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5. Tayside
Childhood Asthma Project
- A controlled
trial of an audit facilitator working with 12 General Practices showed
that the care of children with asthma could be improved through the
use of a predefined protocol for asthma care. Children with asthma or
suspected asthma were identified to the practice and were given an asthma
review. Medical records were reviewed on four occasions and data relating
to their asthma and its treatment were recorded.
-
Bryce
F P, Neville R G, Crombie I K, Clark R A, McKenzie P. Controlled
trial of an audit facilitator in diagnosis and treatment of childhood
asthma in general practice. BMJ 1995 310 838-42
-
McCowan
C, Neville R G, Crombie I K, Clark R A, Warner F C. The facilitator
effect : results from a 4-year follow-up of children with asthma.
Br J GP 1997 47 156-160
-
Research
Poster
-
1.
Social Deprivation, Childhood Asthma and Health Service Utilisation
- Presented at BTS London, Dec 96
-
2.
Asthma and Growth - the links between treatment, health service utilisation
and social deprivation
- Presented at GPIAG Oxford, Jun 98
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6. National
Asthma Management Study
- General
practices from throughout the UK were recruited to this study which
was funded by Allen & Hanbury's Ltd. Participating practices reported
on 30 randomly selected patients with asthma and these reports were
auditted by the Research Unit. Each patient received an individual set
of management recommendations, based on concensus guidelines, and the
management of asthma in each practice was also positively criticised.
This process was carried out for over 400 practices over a two-year
period. The information collected formed the basis of a unique database
on the management of asthma throughout the UK.
-
Neville
RG, Hoskins G, Smith B, Clark RA. Observations on the structure,
process and clinical outcomes of asthma care in general practice.
Br J GP 1996 46 583-587.
-
Research
Posters
- 1.
Observations on the structure, process and clinical outcomes of asthma
care in general practice
- Presented at BTS Conference Dec 96
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7. Asthma
and Growth in Tayside Children
- This project
combined data from the Tayside Childhood
Asthma Project and the Tayside Growth Study (TGS) to investigate
the effect of asthma and its treatment on growth. The study followed
over 3,000 children for a period of four years detailing asthma management
and linking growth measurements taken by TGS. The aims of the study
were to discover if asthma effected growth, if so was the disease or
the treatment and how important was this impairment. The project was
funded by the National Asthma Campaign .
-
The
findings of the project indicate that there is a small sub-group of
children with asthma who suffer from growth impairment. This is on
average 6cm in a 14-year old boy. Clinicians have the difficult decision
of whether to control asthma at the cost of growth or trying to find
a balance, keeping the child free from excessive effects of their
asthma but still allowing optimum growth.
-
Neville
RG, McCowan C, Crombie IK, Thomas GE. Asthma and Growth - Cause
for concern? Ann Hum Biol 1996 23 323-33
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8. Economic
Evaluation of Acute Asthma Attacks
- This study
highlights the cost to the health care service of treating patients
who have suffered an exacerbation of asthma. Patient populations susceptible
to exacerbations were identified from an existing database of 2,275
patients from throughout the United Kingdom. Published unit costs were
applied to value resource use for each individual patient and the cost
to the health service was then calculated.
- By investigating
the treatment costs in patients who experienced an asthma attack within
a specified time period it was possible to quantify costs of differing
patterns of care and estimate the health service cost of managing an
asthma attack. Given the major cost burden to the health service it
is possible that investment in increased use of preventative therapy
in primary care could greatly reduce the economic burden on secondary
care by reducing asthma instability. Further evaluation on outcomes
over a longer period is required.
- Hoskins
G, Neville RG, Smith B, Clark RA. Economic implications of an asthma
attack. Eur Res J 1997 10;(25)226s
- Research
Poster
- Economic
implications of an astma attack- Presented at the European Respiratory
Society Berlin, Sep 97
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