The link between practice nurse training and asthma outcomes

Abstract

Thirty Two(41%) practices submitted details on 954 asthma patients. Positive patient outcomes were associated with practices operating a clinic organised by a specially trained asthma nurse(n=11). This group had fewer patients with symptoms(p<0.01), fewer acute attacks(p<0.01), more aggressive use of short course systemic steroids(p<0.001) and fewer patients with days lost due to asthma(p<0.05), compared to practices with clinics run by nurses not in possession of a diploma(n=14).These associations are likely to be clinically important. To improve patient management there is a strong case for recommending that all general practices employ a nurse with special training in asthma.

British Guideline on the Management of Asthma

“…407 BeneÞ ts include reduced school or work absence, reduced exacerbation rate, improved symptom control and reduced attendance at the emergency department. 629,630 Proactive structured review, as opposed to opportunistic or unscheduled review, is associated with reduced exacerbation rate and days lost from normal activity. 626,631,632 It is difÞ cult to be prescriptive about the frequency of review as need will vary with the severity of the disease.…”

“…Sub-optimal control of asthma leading to exacerbation is more expensive to manage than well controlled asthma. 630 Early discharge schemes from hospital and emergency departments may be cost effective. 445,676 The safety of telephone help lines has not been established.…”

BTS statement on criteria for specialist referral, admission, discharge and follow-up for adults with respiratory disease

“…Regular review of patients with asthma by primary care nurses, primary care physicians or secondary care physicians is associated with favourable clinical outcome including reduced school and work absence, a reduced exacerbation rate and improved symptom control 6 – 8…”

Does specialist respiratory education make a difference to practice?

“…Other literature does seek to expose a link between practice and educational preparation (Cleland et al, 2006;Hoskins et al, 1999) though selection biases skewed results a link, albeit indirect, between education and clinical outcomes is made. This link is further supported by Considine et al (2005) when assessing the effect of a self-directed learning package on emergency nurses' knowledge of oxygen therapy.…”

“…Other studies (Hoskins et al, 1999;Considine et al, 2005;Considine et al, 2007;Considine and Botti, 2006;Sheikh et al, 2007) have more overtly tried to support the connection between education of healthcare professionals and clinical effectiveness but have focused on very specific interventions rather than a patient group. The current study attempts to further augment this evidence in its suggestion that a wider curriculum may result in not only altered clinical practice but also wider issues such as awareness and personal perception.…”