Prescribing and hospital admissions for asthma in east London

Griffiths, Chris; Naish, John; Sturdy, Patricia; Pereira, Filomena

doi:10.1136/bmj.312.7029.481

Cited by 96 publications

(39 citation statements)

References 4 publications

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“…Much of the research in this subject has tried to validate indicators by examining their association with other process measures. For example, several researchers have looked at the association between the ratio of inhaled corticosteroids to inhaled bronchodilators and admission rates for asthma 11 12 13. The next step in this research will be to validate the indicators against better quality measures.…”

Section: How Is Pact Usedmentioning

confidence: 99%

What can PACT tell us about prescribing in general practice?

Majeed

Evans

Head

1997

BMJ

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Objective: To study the extent to which general practitioners' questioning behaviour in routine practice is likely to encourage the adoption of evidence based medicine. Design: Self recording of questions by doctors during consultations immediately followed by semistructured interview. Setting: Urban Australian general practice. Subjects: Random sample of 27 general practitioners followed over a half day of consultations. Main outcome measures: Rate of recording of clinical questions about patients' care which doctors would like answered; frequency with which doctors found answers to their questions. Results: Doctors asked a total of 85 clinical questions, at a rate of 2.4 for every 10 patients seen. They found satisfactory answers to 67 (79%) of these questions. Doctors who worked in small practices (of one or two doctors) had a significantly lower rate of questioning than did those in larger practices (1.6 questions per 10 patients v 3.0 patients, P = 0.049). No other factors were significantly related to rate of questioning. Conclusions: These results do not support the view that doctors routinely generate a large number of unanswered clinical questions. It may be necessary to promote questioning behaviour in routine practice if evidence based medicine and other forms of self directed learning are to be successfully introduced.

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Section: How Is Pact Usedmentioning

confidence: 99%

What can PACT tell us about prescribing in general practice?

Majeed

Evans

Head

1997

BMJ

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“…Using a univariate analysis, we reported a significant association between admission rates for asthma by individual east London practices and the appropriateness of their prescribing (as the ratio of asthma prophylaxis to bronchodilator prescribing) 7 8. This relation was strongest for patients aged 5-64 years, for whom the diagnosis of asthma is most secure 9 10.…”

Section: Introductionmentioning

confidence: 99%

Hospital admissions for asthma in east london: associations with characteristics of local general practices, prescribing, and population

Griffiths¹,

Sturdy²,

Naish³

et al. 1997

BMJ

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Objective: To determine the relative importance of appropriate prescribing for asthma in explaining high rates of hospital admission for asthma among east London general practices. Design: Poisson regression analysis describing relation of each general practice's admission rates for asthma with prescribing for asthma and characteristics of general practitioners, practices, and practice populations. Setting: East London, a deprived inner city area with high admission rates for asthma. Subjects: All 163 general practices in East London and the City Health Authority (complete data available for 124 practices). Main outcome measures: Admission rates for asthma, excluding readmissions, for ages 5-64 years; ratio of asthma prophylaxis to bronchodilator prescribing; selected characteristics of general practitioners, practices, and practice populations. Results: Median admission rate for asthma was 0.9 (range 0-3.6) per 1000 patients per year. Higher admission rates were most strongly associated with small size of practice partnership: admission rates of singlehanded and two partner practices were higher than those of practices with three or more principals by 1.7 times (95% confidence interval 1.4 to 2.0, P < 0.001) and 1.3 times (1.1 to 1.6, P = 0.001) respectively. Practices with higher rates of night visits also had significantly higher admission rates: an increase in night visiting rate by 10 visits per 1000 patients over two years was associated with an increase in admission rates for asthma by 4% (1% to 7%). These associations were independent of asthma prescribing ratios, measures of practice resources, and characteristics of practice populations. Conclusions: Higher asthma admission rates in east London practices were most strongly associated with smaller partnership size and higher rates of night visiting. Evaluating ways of helping smaller partnerships develop structured proactive care for asthma patients at high risk of admission is a priority.

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“…10 A second potential measure of adequate asthma therapy that has been evaluated is the ratio of controller medication to reliever or total inhaled asthma medication, but the data have been conflicting. Aveyard, 11 Griffiths et al, 12 and Gottlieb et al 13 observed a correlation between prescribing practices, as measured by the ratio of therapy with controller medication to therapy with reliever medication, and emergency asthma admission rate, whereas Shelley et al 14 observed no correlation between the hospital admission rate for asthma and the controller medication/reliever medication ratio. Studying this ratio in individual patients, Fuhlbrigge et al 15 reported an inverse relationship between this ratio and the risk of subsequent asthma ED visits but only in children to whom fewer than four canisters of reliever medication were dispensed per person per year.…”

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confidence: 96%