It's good to talk… … but do I really need to see you? The potential of telephone consultations for providing routine asthma care

Abstract

The British Thoracic Society / Scottish Intercollegiate Guideline Network (BTS/SIGN) British Guideline on Asthma Management advocates a regular, structured review for all patients with asthma.¹ This seems reasonable. Regular review has been linked with improved asthma morbidity.² As clinicians we have a professional responsibility as well as compelling medicolegal reasons to review patients for whom we are prescribing. Theoretically, therefore, we should welcome the inclusion of routine asthma reviews as a quality indicator in the new UK General Medical Services (GMS) Contract.³

In practice, however, people with asthma are reluctant to attend for asthma reviews.⁴ Despite over a decade of proactive asthma care in general practice only about a third of patients are seen each year for a routine review.^4,5 Anecdotally, this contrasts with relatively high attendance at diabetic and coronary heart disease clinics (over 90% in my practice). We know that asthma affects quality of life⁴ but perhaps it is not sufficiently inconvenient, or not perceived as sufficiently serious, to warrant the investment of time and effort involved in attending a clinic review. If we are to achieve the 70% target set by the GMS Contract we will need to think outside the four walls of our surgeries.