Using information from asthma patients: a trial of information feedback in primary care

Abstract

Feedback to general practitioners of information about patients' asthma does not on its own lead to change in the outcome of clinical care.

Guidelines into practice: An international pilot study of “Asthma Crystal Byte”

“…7,8 Unfortunately such attempts are not often successful because health care professionals struggle to link the theory of ideal practice to the realities of clinical care of individuals. 9,10 In the United Kingdom (UK) a series of general practice and nurse audit projects based on the British Asthma Guidelines led to the development of a system of providing patient specific feedback and audit critiques. 11,12,13,14,15 A database of over 12,000 patients with asthma in the UK provided a means to compare individual patients with matched controls, and in turn produce comparative statistics for practices who collaborated in audit projects.…”

Clinician education: a key to implementing asthma guidelines?

“…In a further study, White randomised 23 general practices to receive patient specific morbidity feedback, inserted into patient records, with additional presentations of morbidity data to practice teams. 4 Surprisingly, no improvements in patient morbidity or prescribing were found. Non-educational methods may have a place: a similar study testing prompts in medical records placed by an audit facilitator, but without direct educational contact between facilitator and clinicians, showed improved asthma prescribing and diagnosis over a year, 11 but no longer.…”

“…2 3 In contrast, patient outcomes were unchanged when GPs took part in small group education without guidelines development. 4 Unfortunately, de novo guidelines development within individual practices is not a practical approach. Two studies suggest that education can improve use of asthma guidelines and improve care even in socially deprived areas where underdeveloped practice is common.…”

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

“…For example, Levy's study which showed no difference between the use of high dose fluticasone and oral steroids has ramifications for the structure of management plans. 38 New strategies using facilitators 39,40 and GP feedback information sheets, 41 whilst not able to demonstrate sustained improvements in clinical care, are important in shaping the direction of general practice asthma care.…”