Systems for the management of respiratory disease in primary care — an international series: United Kingdom

Worth, Allison; Pinnock, Hilary; Fletcher, Monica; Hoskins, Gaylor; Sheikh, Aziz

doi:10.4104/pcrj.2010.00070

Cited by 13 publications

(18 citation statements)

References 40 publications

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“…This system rewards general practices that achieve targets set over a wide range of clinical indicators. For instance, physicians are encouraged to perform annual disease reviews for their asthma patients, which include an assessment of disease control [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Prescribed therapy for asthma: therapeutic ratios and outcomes

et al. 2015

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BackgroundInhaled corticosteroids (ICS) are the cornerstone of asthma therapy. The ICS-to-total-asthma-medication ratios, calculated from claims data, indicate potentially risky disease management in asthma. Our aim was to assess the utility of ICS-to-total-asthma-medication ratios from primary care electronic medical records (EMRs) in detecting patients at risk of asthma exacerbation, as approached by prescription of oral corticosteroids and/or antibiotics.MethodsRetrospective cohort studies were identified, using the Health Improvement Network general practice database (THIN, United Kingdom) and the Cegedim Longitudinal Patient Data (France). We selected asthma patients aged 16–40 years, with ≥ 4 prescriptions for asthma medications in 2007 and ≥ 1 prescription in 2008. For each country, three groups were defined according to ratio value in 2008: 0% (non-ICS users), <50% (low-ICS-ratio group) and ≥50% (high-ICS-ratio group). Outcomes were marker of asthma exacerbations: systemic corticosteroids and antibiotics. They were compared between groups in each country.ResultsAmong 38,637 British and 4,587 French patients, higher numbers of prescriptions per patient of systemic corticosteroids, antibiotics and total asthma medications were observed in the low-ICS-ratio groups compared to other groups (p < 0.0001 for each outcome in both countries). Likewise, low-ICS-ratio patients had more medical contacts (p < 0.0001 in both countries), suggesting poorly controlled asthma. ICS-treated patients had lower risks of receiving systemic corticosteroids in 2008 in the high-ICS-ratio group, compared to the low-ICS-ratio group: RR = 0.54, 95%CI = [0.50-0.57] and RR = 0.78, 95%CI = [0.67-0.91] in the UK and France, respectively.ConclusionsPatients with high ICS-to-total-asthma-medication ratios presented fewer asthma-related outcomes. The low ICS-to-total-asthma-medication ratio calculated with EMRs data reflects insufficient prescribing of ICS relative to all asthma medications, which may lead to deteriorated asthma control.

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Section: Introductionmentioning

confidence: 99%

Prescribed therapy for asthma: therapeutic ratios and outcomes

et al. 2015

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“…Whether the provided care differs between various regions in the Netherlands and between countries remains unknown. Though, previous research also indicates shortcomings in implementation of healthcare guidelines in the UK [52] and USA [53]. Another consideration is that several tests were measured differently in non-COPD subjects, primary care patients and secondary care patients (home environment) compared to tertiary care patients (clinical setting), as also described in the previously published protocol [14].…”

Section: Limitationsmentioning

confidence: 99%

Burden of COPD in patients treated in different care settings in the Netherlands

Smid

Spruit

Houben-Wilke

et al. 2016

Respiratory Medicine

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“…3 4 However, self-management strategies are poorly implemented within general practice. [5][6][7] Internet technology might offer an attractive means for encouraging patients to use self-management strategies within a day-to-day context. 8 This is demonstrated by the increasing number of available apps on…”

Section: Introductionmentioning

confidence: 99%

Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation

et al. 2016

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ObjectivesThe aim of this study was to explore barriers among patients, general practitioners (GPs) and practice nurses to implement internet-based self-management support as provided by PatientCoach for asthma in primary care.SettingPrimary care within South Holland, the Netherlands.ParticipantsTwenty-two patients (12 women, mean age 38 years), 21 GPs (6 women, mean age 52 years) and 13 practice nurses (all women, mean age 41 years).DesignA qualitative study using focus groups and interviews.OutcomesBarriers as perceived by patients, GPs and practice nurses to implementation of PatientCoach.Methods10 focus groups and 12 interviews were held to collect data: 4 patient focus groups, 4 GP focus groups, 2 practice nurse focus group, 2 patient interviews, 5 GP interviews and 5 practice nurse interviews. A prototype of PatientCoach that included modules for coaching, personalised information, asthma self-monitoring, medication treatment plan, feedback, e-consultations and a forum was demonstrated. A semistructured topic guide was used. Directed content analysis was used to analyse data. Reported barriers were classified according to a framework by Grol and Wensing.ResultsA variety of barriers emerged among all participant groups. Barriers identified among patients include a lack of a patient–professional partnership in using PatientCoach and a lack of perceived benefit in improving asthma symptoms. Barriers identified among GPs include a low sense of urgency towards asthma care and current work routines. Practice nurses identified a low level of structured asthma care and a lack of support by colleagues as barriers. Among all participant groups, insufficient ease of use of PatientCoach, lack of financial arrangements and patient characteristics such as a lack of asthma symptoms were reported as barriers.ConclusionsWe identified a variety of barriers to implementation of PatientCoach. An effective implementation strategy for internet-based self-management support in asthma care should focus on these barriers.

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Systems for the management of respiratory disease in primary care — an international series: United Kingdom

Abstract: Introduction: The UK National Health Service (NHS) is essentially publicly funded through general taxation. Challenges facing the NHS include the rise in prevalence of long-term conditions and financial pressures.

Cited by 13 publications

References 40 publications

Prescribed therapy for asthma: therapeutic ratios and outcomes

Prescribed therapy for asthma: therapeutic ratios and outcomes

Burden of COPD in patients treated in different care settings in the Netherlands

Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation

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