BMJ 2003;326:477 ( 1 March )

Primary care

Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial

Hilary Pinnock, General Practice Airways Group clinical research fellow, ^a Robert Bawden, general practitioner, ^b Stephen Proctor, general practitioner, ^c Stephanie Wolfe, respiratory nurse, ^d Jane Scullion, nurse consultant, ^e David Price, General Practice Airways Group professor of primary care respiratory medicine, ^a Aziz Sheikh, NHS/PPP Foundation national primary care postdoctoral researcher. ^f

^a Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY, ^b Botesdale Health Centre, Diss, Norfolk IP22 1DU, ^c Clarendon Medical Centre, Hyde, Cheshire SK14 2AQ, ^d Thorpewood Surgery, Norwich NR7 9QL, ^e Respiratory Unit, Glenfield Hospital, Leicester LE3 9QP, ^f Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE

Correspondence to: H Pinnock, Whitstable Health Centre, Whitstable, Kent CT5 1BZ hpinnock{at}gpiag-asthma.org

Objective: To determine whether routine review by telephone of patients with asthma improves access and is a good alternative to face to face reviews in general practices.
Design: Pragmatic, randomised controlled trial.
Setting: Four general practices in England.
Participants: 278 adults who had not been reviewed in the previous 11 months.
Intervention: Participants were randomised to either telephone review or face to face consultation with the asthma nurse.
Main outcome measures: Primary outcome measures were the proportion of participants who were reviewed within three months of randomisation and disease specific quality of life, as measured by the Juniper mini asthma quality of life questionnaire. Secondary outcome measures included the validated "short Q" asthma morbidity score, nursing care satisfaction questionnaire score, and length of consultation.
Results: Of 137 people randomised to telephone consultation, 101 (74%) were reviewed, compared with 68 reviewed (48%) of the 141 people in the surgery group, a difference of 26% (95% confidence interval 14% to 37%; P<0.001; number needed to treat 3.8). Three months after randomisation the two groups did not differ in the Juniper score (risk difference 0.07 (95% confidence interval 0.40 to 0.27) or in satisfaction with the consultation (risk difference 0.07 (0.27 to 0.13)). Telephone consultations were on average 10 minutes shorter than reviews held in the surgery (mean difference 10.7 minutes (12.6 to 8.8; P<0.001)).
Conclusions: Compared with face to face consultations in the surgery, telephone consultations enable more people with asthma to be reviewed, without clinical disadvantage or loss of satisfaction. A shorter duration means that telephone consultations are likely to be an efficient option in primary care for routine review of asthma.

What is already known on the topic Regular review of patients with asthma reduces morbidity and is endorsed as good practice by UK and international guidelines, but only about a third of patients attend for their annual review Most studies of telephone consultation in primary care have focused on consultations requested by patients rather than their use in the routine review of chronic disease What this study adds Telephone consultations enable more people with asthma to be reviewed Telephone consultations are shorter than face to face consultations, without any apparent clinical disadvantage Patients are satisfied with telephone consultations

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