Table 3 Evidence summary to support practice resources and organisation.
From: Improving primary care management of asthma: do we know what really works?
Practice resources and organisation | Country(Reference) | Study type | Description and study outcomes |
|---|---|---|---|
Registered pt lists and fully integrated computer systems AND Clinical care pathways | UK22 | Questionnaire; no data | SIMPLES, a structured PC approach to reviewing pts with uncontrolled asthma—encompassing pt education monitoring, lifestyle/pharmacological management and addressing support needs. Involves close cooperation between PC and SC. Outcomes: No data available. |
Registered pt lists and fully integrated computer systems AND Clinical care pathways | NL23 | Questionnaire; no data | SIMPLES adapted using a modified e-Delphi approach to assess the stakeholder opinion. Outcomes: Nine-component questionnaire—a robust and holistic approach for difficult-to-manage asthma. No data available. |
Registered pt lists and fully integrated computer systems | UK24 | Cluster-randomised trial in 29 PC practices with 911 at-risk asthma pts | Pilot study showed that PC intervention for targeted at-risk asthma patients had the potential for improving practice level management and reducing asthma emergency admissions. |
Registered pt lists and fully integrated computer systems | UK25 | Pragmatic, 2-arm, RCT; 270 PC practices covering >10,000 registered ‘at-risk asthma’ pts | Aimed to determine whether the creation and integration of at-risk asthma registers into PC reduces asthma-related crisis events for at-risk pts over a 12-month period compared to control practices. Outcomes: No data available. |
Registered pt lists and fully integrated computer systems | UK26 | Retrospective study; 26 at-risk asthma pts and 26 matched controls for 1 year pre- and post-intervention | Implementation/service use costs estimated before and 1 year after introduction of an at-risk register. More ‘at-risk’ than control pts were hospitalised/attended A&E/nebulised for asthma; also used out-of-hours services/attended GP/received OCS (all p < 0.025). Outcomes: After register introduction, no at-risk pts were admitted or attended A&E. |
Registered pt lists and fully integrated computer systems | Multi-national (US, NL, AU, UK, DK)27 | Systematic review of 19 studies representing 16 RCTs (2003–2013) evaluating CCDS for pts with asthma and COPD | Use of CCDS improved asthma and COPD care in 14 of the reviewed studies (74%). There was considerable improvement in healthcare process measures and clinical outcomes. The effect on workload, efficiency, safety, costs, provider and pt satisfaction remain understudied. |
Registered pt lists and fully integrated computer systems | Multi-national (US, NL, UK, ES)28 | Systematic review of 8 RCT CCDS (1990–2012) for professional asthma management | Use of CCDS by HCPs was found to be low, and adherence to the advice was limited. Concluded, if used, CDSS could result in closer adherence to guidelines and improve some clinical outcomes. Better alignment to clinical workflow would enhance their use. |
Registered pt lists and fully integrated computer systems | NL29 | 1-year RCT; 200 adults (18–50 years) with mild–moderate persistent asthma | Pt groups: (i) weekly asthma control monitoring via online ACQ, treatment adjusted via self-management algorithm supervised by an asthma nurse specialist; (ii) usual care. Outcomes: Weekly self-monitoring/treatment adjustment led to improved asthma control in pts with partly/uncontrolled asthma at baseline. |
Access to high-quality lung function testing and other diagnostic tests | Unknown at present30 | Protocol: This will be a systematic review | Clinical prediction models can be used to aid PC asthma diagnosis by estimating outcome; models combine ≥2 predictors, e.g. clinical history/physical examination/test results/treatment response. Outcomes: No data available. |
Access to high-quality lung function testing and other diagnostic tests | NL31 | Observational study | An online support system to advise GPs on pt diagnosis and treatment. Spirometry performed by local GP laboratory; spirometry results, pt history questionnaire, ACQ and CCQ reviewed online by pulmonologist; who advises GP online, supported by a guideline-based algorithm. Outcomes: Number of pts with unstable asthma (ACQ ≥ 1.5) dropped from 245 to 137. |
Access to high-quality lung function testing and other diagnostic tests | NL32 | PC Diagnostic Centre study. 156 pts randomly selected from asthma/COPD-service referrals | Five respiratory specialists assessed spirometry data and pt histories. Facilities developed to provide spirometry testing by specially trained clinicians. GPs reluctant to perform or interpret spirometry themselves may be supported diagnostically by respiratory specialists in an asthma service although the reliability of this advice varies. |
Access to high-quality lung function testing and other diagnostic tests | UK33 | PC study; 678 pts aged 4–80 years with first FeNO assessment at index date | FeNO use to guide ICS initiation/dosing decisions and identify poor adherence. In the year following index date, FeNO use was evaluated in 2 pt cohorts to: (i) identify steroid-responsive disease; (ii) guide asthma management. Outcomes: Algorithms to guide practical FeNO use could improve diagnostic accuracy/asthma regimen tailoring. |
Access literacy/culturally sensitive pt education | No studies found via search |
