Controlled trial of an audit facilitator in diagnosis and treatment of childhood asthma in general practice
BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6983.838 (Published 01 April 1995) Cite this as: BMJ 1995;310:838
- Fiona P Bryce, senior lecturera,
- Ronald G Neville, senior lecturera,
- Iain K Crombie, senior epidemiologist Ronald A Clark, chest physiciana,
- Roland A Clark, project assistanta,
- Pamela McKenzie, project assistanta
- a Tayside Centre for General Practice, University of Dundee, Westgate Health Centre, Dundee DD2 4AD Fiona F Bryce, research assistant
- Correspondence to: Dr Neville.
- Accepted 8 March 1995
Abstract
Objective: To test whether an audit facilitator could alter the pattern of diagnosis and treatment of childhood asthma.
Design: Randomised stratified controlled trial.
Setting: 12 general practices in Tayside.
Subjects: 3373 children aged 1-15 inclusive who had symptoms suggestive of asthma or possible asthma drawn from a systematic review of 10 725 general practice case records.
Intervention: Children were targeted for a clinical review by their general practitioner or practice nurses.
Main outcome measures: Asthma related consultations, precriptions, hospital attendances, and health service costs 12 months before and after study.
Results: Compared with controls (n=1563) the intervention group (n=1585) had more practice initiated consultations for asthma (relative risk 2.18 (95% confidence interval 1.74 to 2.73)), new diagnoses of asthma (2.83 (2.26 to 3.54)), and past diagnoses reaffirmed (1.30 (1.08 to 1.58)), and they were more frequently prescribed inhaled cromoglycate (1.52 (1.02 to 2.25)). Hospital inpatient day rates fell from 152 to 122 in the intervention group and rose from 69 to 117 in the control group between the year before and the year after study. Total primary care costs rose from pounds sterling30118 to pounds sterling37243 in the intervention group and fell from pounds sterling29131 to pounds sterling27990 in the control group. Hospital care cost fell in the intervention group from pounds sterling25406 to pounds sterling20727 and rose in the control group from pounds sterling12699 to pounds sterling19650.
Conclusion: An audit facilitator can favourably influence the pattern of diagnosis and treatment of childhood asthma in general practice. This may have an impact on health service costs.
Key messages
Key messages
Controlled trial of an audit facilitator is feasible in primary care
Intervention of an audit facilitator resulted in desirable changes in the diagnosis and treatment of asthma in children in general practice
Such intervention may also have had an impact on the use of hospital resources and on health care expenditure
Footnotes
- Accepted 8 March 1995