Intended for healthcare professionals


Integrated care for asthma: a clinical, social, and economic evaluation

BMJ 1994; 308 doi: (Published 26 February 1994) Cite this as: BMJ 1994;308:559
  1. N Drummond,
  2. M Abdalla,
  3. J K Buckingham,
  4. J A G Beattie,
  5. T Lindsay,
  6. L M Osman,
  7. S J Ross,
  8. A Roy-Chaudhury,
  9. I Russell,
  10. M Turner,
  11. J G Douglass,
  12. J S Legge,
  13. J A R Friend for Grampian Asthma Study of Integrated Care (GRASSIC)
  1. Health Services Research Unit, University of Aberdeen, Aberdeen AB9 2ZD
  2. Thoracic Medicine Unit, Aberdeen Royal Hospitals Trust, City Hospital, Aberdeen AB9 8AU
  1. Correspondence and requests for reprints to: Mr Drummond.
  • Accepted 2 November 1993


Objective : To evaluate integrated care for asthma in clinical, social, and economic terms.

Design : Pragmatic randomised trial.

Setting : Hospital outpatient clinics and general practices throughout the north east of Scotland.

Patients : 712 adults attending hospital outpatient clinics with a diagnosis of asthma confirmed by a chest physician and pulmonary function reversibility of at least 20%.

Main outcome measures : Use of bronchodilators and inhaled and oral steroids; number of general practice consultations and hospital admissions for asthma; sleep disturbance and other restrictions on normal activity; pyschological aspects of health including perceived asthma control; patient satisfaction; and financial costs.

Results : After one year there were no significant overall differences between those patients receiving integrated asthma care and those receiving conventional outpatient care for any clinical or psycho-social outcome. For pulmonary function, forced expiratory volume was 76% of predicted for integrated care patients and 75% for conventional outpatients (95% confidence interval for difference -3.6% to 5.0%). Patients who had experienced integrated care were more likely to select it as their preferred course of future management (75% (251/ 333) v 62% (207/333) (6% to 20%); they saved pounds sterling 39.52 a year. This was largely because patients in conventional outpatient care consulted their general practioner as many times as those in integrated care, who were not also visiting hospital.

Conclusion : Integrated care for moderately severe asthma patients is clinically as effective as conventional outpatient care, cost effective, and an attractive management option for patients, general practioners, and hospital consultants.


    • Accepted 2 November 1993
    View Full Text