Table 4 Evidence summary to support workforce issues.
From: Improving primary care management of asthma: do we know what really works?
Workforce | Country | Study type | Description and study outcomes |
|---|---|---|---|
1, 2, 3 | CA34 | Retrospective database study, adults. 2008–2009. PC physician/network visited (n = 1,502,916); usual care (n = 1,109,941) | PC networks designed to facilitate access to interprofessional, team-based care, using AHPs skills in providing coordinated healthcare. Health outcomes associated with PC networks compared with conventional PC. Outcomes: Pts in network practices less likely to visit ED for conditions such as asthma; fewer ED visits and shorter hospital stays. |
1, 2, 3 | US36 | Implementation study. 42 pharmacies, 2419 pts and 1284 provider interventions | Community pharmacist reviews of pts with poorly controlled asthma/no recent physician asthma review; physician referral was a service component. Outcomes: Benefits in asthma control, knowledge, inhaler technique, AAP ownership, ARQOL, and adherence. |
1, 2, 3 | AU37 | A pragmatic cluster-randomised trial 96 pharmacists, 570 pts | Community-based asthma service by specially trained pharmacists: 3 vs. 4 visits in 6 months (12-month follow-up). Outcomes: Clinically important outcomes in both groups with minimal intervention, 3-visit service feasible/effective to implement, with 12-month review. |
1, 2, 3 | US38 | Prospective pre-post study of pts receiving intervention for 9 months; 126 pts | Pts received physician−pharmacist collaborative management in PC. Pharmacists provided AAP/education/physician referral as necessary. Outcomes: Asthma-related ED visits decreased by 30% in the 9 months. |
1, 2, 3 | US39 | 5 community-based clinics Retrospective pre- and post-intervention analysis | A team-based education approach involving an electronic clinical quality management system; reminders/provision of AAPs by nurses. Outcomes: Increased AAPs prescribed, pt outcomes were not measured. |
2, 3 | UK40 | Community-based, randomised, open-label pragmatic study | SLS; a collaboration between physicians, nurses, hospital staff and pharmacists linked using electronic pt health record, improving HCP communication. Outcomes: Improved asthma control (ACT increase). |
2, 3 | BR44 | Implementation study 132 PC physicians & nurses Aim to decrease number of respiratory-related (Asthma/COPD) referrals | Educational intervention (matrix support, evaluated in PC): physicians/nurse training/support from specialists (e.g. tailored education/joint consultations/case discussions). Outcomes: referrals decreased by >50% from 13.4 to 5.4 cases/month (P = 0.09). An effective tool to improve asthma knowledge and promote changed PC/SC relations. Pt outcomes not measured. |
4 | US41 | Implementation study. 57 practices, 15,508 pts Pre-post | CATP; a provider-level intervention to improve guideline use and asthma care (education and pt resources). Outcomes: CATP improved guideline care processes but not pt outcomes, of practices: 40.4% increased ICS use, 53.2% increased AAP use; 78.7% initiated/increased spirometry use. |
4 | US42 | Implementation study (asthma pts 5–64 years) 12 months pre- and post-CATP implementation 9 practices; 2678 pts | Compared 12 months pre- and post-use of the CATP in PC practice. Outcomes: An improvement in asthma quality processes—increase in rate of asthma severity measurement and medication management, no change in outcomes across multiple domains: exacerbations, utilisation, symptom scores, and pulmonary physiology measures. |
4 | CA43 | Pragmatic improvement study. 23 physicians, 25 AHPs; 12-month pre/post-intervention knowledge | Mentorship-based intervention with interactive education/hands-on training/ unstructured peer mentoring. Aimed to address PC underuse/quality of spirometry. Outcomes: Improved spirometry test acceptability, poor overall spirometry usage (remained < 40%), health outcome effects not measured. |
5 | DK35 | Consultation guide based on GINA guidelines | Consultation included symptom evaluation, treatment, compliance, lung function, scheduled follow-up appointment based on asthma control level. Outcomes: Asthma control improved when a systematic asthma management approach was introduced/applied by dedicated nurses. |
5 | ES45 | Cluster controlled implementation study 57 practices 400 PC physicians and nurses, 6/12 pre−post-intervention 7 control | GP practices received an education programme for use of respiratory health status tools. Outcomes: In intervention practices slight improvement in pts with a record of a health status score (ACT, CAT and/or mMRC), but absolute % score recorded was still relatively low (1.70%), even after intervention. No differences in clinical outcomes. |
5 | AU46 | RCT aged ≥55 with asthma N = 58 intervention group n = 56 control group | Groups: brochure only (controls); person-centred education (intervention). Outcomes: Intervention pts had improved asthma control, adherence, AAP ownership, ARQOL and exacerbations over 12 months vs. control pts. |
5 | Global47 | Literature review of 24 studies | Reviewing conceptualisation/practice in PC. Enablement influenced by: open communication style/longer consultations/pt centredness of HCP. Outcomes: 2 RCTs suggest enablement linked to better pt outcomes. |
5 | DE85 | 5-year programme 2006–2010. N = 109,042 in year 5 | German asthma management programme. Outcomes: Enhanced care quality; improved symptoms/adherence/pharmacotherapy/hospitalisation. |
