Asthma nurse practice improves outcomes and reduces costs in primary health care

Lindberg, Mats; Ahlner, Johan; Ekström, Thommy; Jonsson, Dick; Möller, Margareta

doi:10.1046/j.1471-6712.2002.00054.x

Cited by 44 publications

(64 citation statements)

References 18 publications

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“…To the best of the authors9 knowledge this is the first study on childhood asthma in which traditional physician care was substituted by nurse-led care, resulting in a reduction of healthcare costs. This confirms previous studies in which nurse-led care in adults with selected chronic disorders in primary care was more cost-effective than traditional physician-led care [34][35][36]. In secondary care results in adults have been conflicting.…”

Section: Discussionsupporting

confidence: 85%

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Kamps¹,

Roorda²,

Kimpen³

et al. 2004

Eur Respir J

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The high burden of asthma on healthcare utilisation and costs warrants economic appraisal of management approaches. The authors previously demonstrated that the efficacy of nurse-led outpatient management of childhood asthma was comparable to management by a paediatrician and now report on the healthcare utilisation and costs of both management approaches.A total of 74 newly referred children with asthma were randomly assigned to a 1-yr follow-up by paediatricians or asthma nurse. Healthcare utilisation was recorded and associated costs calculated for both management approaches.There were no significant differences in healthcare utilisation except for the total time spent on patient contact (136(n=14) versus 187(n=41) min, for patients followed-up by paediatrician and an asthma nurse repectively). Costs within the healthcare sector were reduced by 7.2% in favour of nurse-led care. The reduction in costs was solely attributable to a 17.5% reduction in the costs of outpatient visits. Nurse-led care appeared to be cost-saving even if the duration of follow-up visits would be twice that of doctor9s visits. Overall healthcare costs (within and outside the healthcare sector) were 4.1% lower for nurse-led outpatient management compared to traditional medical care.Nurse-led outpatient management of childhood asthma can be provided at a lower cost than medical care by paediatricians.

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Section: Discussionsupporting

confidence: 85%

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Kamps¹,

Roorda²,

Kimpen³

et al. 2004

Eur Respir J

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“…221,227 The majority (n = 9) were conducted in primary care or community settings, 218,219,226,228,229,[234][235][236] four in managed care organisations (MCOs), 220,222,223,225 one in secondary care, 230 three in schools 221,224,231 and one (two reports) was a national multisetting initiative.…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…228 Seven were based on longitudinal data, 220,223,[230][231][232][233][234][235] one with a control cohort, 229 and two uncontrolled before-and-after 221,236 or cross-sectional studies. 227 This resulted in substantial variation in quality assessment, ranging from 10 to 24 out of a possible score of 28. 48 Common reasons for low quality included lack of information on participants lost to follow-up (n = 15) and/or whether participants were representative of the whole eligible population (n = 11).…”

Section: 233mentioning

confidence: 99%

“…There was no difference in either trial in asthma control or use of health-care resources. 229,236 Lindberg et al 227 reports a cross-sectional audit of an existing nurse-led asthma service in Sweden and compared it to seven neighbouring practices. The nurse-led clinic was associated with greater ownership of PAAPs, and fewer asthma symptoms, though more days lost from work than the control group.…”

Section: Primarily Organisational Changementioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

345

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…10 The Swedish Respiratory Group in Primary Care established criteria for asthma clinics in 1998, 10,11 and these criteria have been used to define asthma clinics in this study. Studies evaluating asthma clinics have demonstrated improvements in some aspects of asthma control, [12][13][14] and the need for more good quality trials has been highlighted. 15 Previous studies on changes in quality of life have not been able to show improvements in patients attending asthma clinics.…”

Section: Introductionmentioning

confidence: 99%

Primary health care centres with asthma clinics: effects on patients' knowledge and asthma control

Lisspers

Ställberg

Hasselgren

et al. 2009

Primary Care Respiratory Journal

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Aim: To evaluate outcomes for patients attending primary care centres with and without asthma clinics. Methods:A cross-sectional survey at 42 primary health care centres randomly selected according to organisation of asthma care, 14 with complete, 14 with incomplete and 14 with no asthma clinic according to national criteria. 1,477 randomly selected patients 15-45 years received two questionnaires. Outcomes were: patients' knowledge of asthma; asthma control; and quality of life.Results: Patients attending primary health care centres with asthma clinics reported more knowledge of asthma but similar levels of asthma control and quality of life. Patients who reported they had visited the asthma nurse during the last year had more knowledge but similar asthma control and quality of life compared to patients who reported they had not. However, with more time allocated for the nurse, 44% achieved asthma control compared with 27% at asthma clinics with less time (p<0.003). Conclusions:Having an asthma clinic at a primary health care centre improves asthma patients' knowledge of the disease, and better asthma control is achieved if the nurse is allocated more time.

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Asthma nurse practice improves outcomes and reduces costs in primary health care

Abstract: This alternative asthma strategy, ANP, improved asthma care in primary health care and resulted in economic advantages in the health care sector. However the result may only be generalized to other practices working with asthma nurses in the same way.

Cited by 44 publications

References 18 publications

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Primary health care centres with asthma clinics: effects on patients' knowledge and asthma control

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