International Journal for Quality in Health Care Advance Access originally published online on April 14, 2005
International Journal for Quality in Health Care 2005 17(3):209-215; doi:10.1093/intqhc/mzi036
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Results of a national asthma campaign survey of primary care in Scotland
1 Health Informatics Centre, Mackenzie Building, University of Dundee, Dundee, 2 Chest Clinic, Aberdeen Royal Infirmary, Aberdeen, 3 Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK
Objectives. To identify within primary care in Scotland how far procedures for asthma review and patient education match guideline recommendations.
Design and setting. Telephone survey of a one in four stratified random sample of all 1058 general practices in Scotland.
Participants. Practice nurses, general practitioners.
Main outcome measures. Number of practices matching guideline recommendations for asthma review, targeting of care, use of structured asthma records, provision of management plans, education, and regular audit.
Results. Of 276 general practices contacted 91% (251) completed the questionnaire; 93% (228) ran an asthma review service; 74% (166) employed a specially trained asthma nurse; 39% (106) had a policy for providing action plans; 63% (155) had carried out an asthma audit in the previous 3 years; 76% (218) used a structured tool in consultations, 46% with use of computer technology, 34% used only a manual stamp. Sixty-six per cent (173) had searched for patients overusing ß2 agonists; 32% (79) had searched for patients on medication treatment step 3 and above. Single- or two-partner practices were less likely to follow guideline recommendations but neither rurality nor deprivation was related to guideline compliance.
Conclusions. Three-quarters of Scottish general practices have trained asthma nurses and offer patients asthma review, but only a minority have proactive care procedures for targeting patients or a policy for providing patients with action plans. Practice systems are underused for identifying ‘at-risk’ patients. There is a need for proactive procedures and provision of self-management materials to patients. Access to trained asthma nurses needs to be improved.
Keywords: asthma, clinical, guidelines, primary care, process of care, review, structured care
Address reprint requests to Gaylor Hoskins, Health Informatics Centre, Mackenzie Building, University of Dundee, Kirsty Semple Way, Dundee DD2 4BF, UK. E-mail: g.hoskins{at}chs.dundee.ac.uk