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British Guideline on the MAnAGeMent of AsthMA
8 organisation and delivery of care, and audit
8.1 routine PriMAry CAre
8.1.1 ACCESS TO ROUTINE PRIMARy CARE
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Primary care services delivered by doctors and nurses trained in asthma management improves
diagnosis, prescribing, education, monitoring, and continuity of care 625,626 Successful training
programmes typically include outreach educational visits to practices or practitioners using
interactive educational methods focused around clinical guidelines, occasionally including
audit and feedback of care. 625,627,628
A All people with asthma should have access to primary care services delivered by doctors
and nurses with appropriate training in asthma management.
Audit the percentage of clinicians who have taken part in a suitable asthma educational
update within last two years.
8.1.2 STRUCTURED REvIEW
Proactive clinical review of people with asthma improves clinical outcomes. Evidence for benefit
is strongest when reviews include discussion and use of a written action plan. 407 Benefits 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 difficult to be prescriptive about the frequency of review as
need will vary with the severity of the disease. Outcome is probably similar whether a practice
nurse (PN), or a general practitioner (GP) conducts the review. Clinicians trained in asthma
management achieve better outcomes for their patients. 626,633,634
A in primary care, people with asthma should be reviewed regularly by a nurse or doctor
with appropriate training in asthma management. review should incorporate a written
action plan.
Audit the percentage of patients reviewed annually. Consider focusing on particular
groups such as those overusing bronchodilators, patients on higher treatment steps,
those with exacerbations or from groups with more complex needs.
Audit the percentage of patients receiving action plans. Consider focusing on subgroups
listed above.
READ coding of patients who are newly diagnosed or register at a practice will ensure a
meaningful database for audit and review purposes. Specifically identifying patients with high
risk asthma (eg those with frequent admissions) in an effort to target more detailed input is
logical but supported by limited evidence. 635 Not all patients want regular review, or are willing
to attend a pre-arranged appointment. Reviews carried out by telephone may be as effective as
those using face-to-face consultations, 636 but face-to-face review will be appropriate for some
patients, such as those with poor asthma control or inhaler-related problems.
B Consider carrying out routine reviews by telephone for people with asthma.
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