The contribution primary care (general practice) has made to asthma care in the past twenty years

I, Charlton

doi:10.1038/pcrj.1997.10

Cited by 3 publications

(3 citation statements)

References 21 publications

(25 reference statements)

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“…Asthma is now recognised and treated as a chronic illness to which strategies of control of symptoms and prevention of acute attacks can be applied successfully. There has been an increase in general practitioner interest,4 and practice nurses have developed expertise in managing asthma with specialist training courses and qualifications 5. Increasing input to the care of asthma in general practice has been seen to be important, not only because of the high prevalence of asthma,6 which makes it one of the common chronic medical conditions in the UK, but also since most asthma deaths occur outside hospital 7…”

mentioning

confidence: 99%

Scottish Confidential Inquiry into Asthma Deaths (SCIAD), 1994-6

Bucknall

Slack

Godley

et al. 1999

Thorax

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Background-There have been important changes in the organisation of care for patients with asthma since asthma deaths were studied in the 1980s by the British Thoracic Association (BTA), with greater emphasis on long term control of symptoms and the use of preventive therapy. Recent trends in routine statistics show a decline in population death rates. Methods-A confidential review was undertaken of general practice and hospital records and interviews with general practitioners of patients dying in mainland Scotland between January 1994 and December 1996 with a principal diagnosis of asthma recorded by the Registrar General's OYce. Panel assessment of the cause of death was carried out and a number of possible adverse factors were identified. The data from the 15-64 year age group were compared with similar data from the earlier study by the BTA. Results-Over the three year period 95 deaths of 235 studied (40%) were confirmed as being due to asthma. Taking account of diVerent methods of case ascertainment used in the BTA and this study, a fall in the calculated rate of "deaths assessed as due to asthma" was found from 2.51 (95% CI 2.34 to 2.68) per 100 000 population in 1979 to 1.26 (95% CI 1.19 to 1.33) per 100 000 population in 1994-6. Fewer individual adverse factors were identified in clinical management, with appropriate routine management in 59% and management of the final attack satisfactory in 71%. Patient factors such as poor compliance, lack of peak expiratory flow (PEF) measurements, and overuse of reliever medication without inhaled corticosteroids, and psychosocial problems, notably depression, were confirmed as important contributing factors. Four of five patients under 16 years of age who died were found to have problems with routine management. Conclusions-Thispopulation based study documents important improvements in the standard of asthma care as well as a significant decline in the rate of deaths due to asthma over a period during which the organisation of care has changed and the chronic nature of the disease has been acknowledged. Strategies which might have a further impact include the greater use of PEF recordings, particularly during acute attacks, to document recovery, prescription monitoring of the underuse of inhaled corticosteroids, consideration of the use of combined preparations where persistent overuse of bronchodilators is occurring, and increased input for young patients whose routine management is proving diYcult. (Thorax 1999;54:978-984)

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confidence: 99%

Scottish Confidential Inquiry into Asthma Deaths (SCIAD), 1994-6

Bucknall

Slack

Godley

et al. 1999

Thorax

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“…There was clear evidence of delayed diagnosis [6,7], under treatment [8], and ongoing concerns regarding preventable asthma deaths [9], often in patients with identifiable psychosocial and behavioural risk factors [10,11]. This need for improvement in primary care management led to the development of GP specialinterest groups (such as the General Practice Airways Group (GPIAG) in the UK [12]) and an evolution in the role of the primary care asthma nurse [13,14]. This development was replicated in many other countries worldwide, culminating in the formation of the International Primary Care Respiratory Group (IPCRG) in 2000, an organisation which now has thousands of members in 34 countries who have a special interest in primary care respiratory medicine.…”

Section: The Ipcrg Guidelines: Developing Guidelines For Managing Chrmentioning

confidence: 99%

What's in this issue?

Schayck

Stephenson²,

Sheikh

2005

Primary Care Respiratory Journal

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“…In 1985, data over a two-year period from New Zealand showed that in 39% of asthma deaths there were psychosocial factors which had probably contributed to the patient's death [4]. These early studies contributed to the increasing interest in primary care management of asthma over the next fifteen years, as shown by the development of groups such as the General Practice Airways Group (GPIAG) [5] and the evolving role of the primary care asthma nurse [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

An ongoing Confidential Enquiry into asthma deaths in the Eastern Region of the UK, 2001–2003

Harrison¹,

Stephenson²,

Mohan³

et al. 2005

Primary Care Respiratory Journal

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Between 1988 and 2003 there was a downward trend in asthma mortality rate in East Anglia. In 2001-2003, misclassification of deaths attributed to asthma was still common. Most patients who die of asthma have severe asthma. In 81% of cases, behavioural and psychosocial factors contributed to the patient's death. In 80% of deaths the final attack was not sudden, and may have been preventable. Almost all sudden deaths occurred between April and August, suggesting a seasonal allergic cause. In two-thirds of asthma deaths, medical management failed to comply with national guidelines. 'At-risk' asthma registers in primary care may improve recognition and management of 'at-risk' patients.

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The contribution primary care (general practice) has made to asthma care in the past twenty years

Cited by 3 publications

References 21 publications

Scottish Confidential Inquiry into Asthma Deaths (SCIAD), 1994-6

Scottish Confidential Inquiry into Asthma Deaths (SCIAD), 1994-6

What's in this issue?

An ongoing Confidential Enquiry into asthma deaths in the Eastern Region of the UK, 2001–2003

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