Skip to main content
PMC home page
Quality in Health Care : QHC logoLink to Quality in Health Care : QHC
. 1996 Sep;5(3):134–143. doi: 10.1136/qshc.5.3.134

Organisation of asthma care: what difference does it make? A systematic review of the literature.

A J Eastwood 1, T A Sheldon 1
PMCID: PMC1055397  PMID: 10161527

Abstract

OBJECTIVES: To evaluate the effectiveness of different forms of organisation (delivery) of asthma care. METHODS: A systematic review of the published evidence of effectiveness organisational methods of asthma management. Searches on computerised databases including Medline, CINAHL, and HELMIS, and relevant citations and letters to experts were used to identify relevant studies. RESULTS: 27 studies were identified that evaluated different organisational methods of delivery across both primary and secondary sectors, such as shared care, general practice asthma clinics, outpatient programmes, inpatient admissions policies, and the use of specialists. Only one third of the studies used a randomised controlled trial and many had small sample sizes. No conclusive evidence was found to favour any particular organisational form, although limited evidence would suggest that specialist care is better than general care and that shared care can be as effective as hospital led care. CONCLUSIONS: There is little good published research evaluating different ways of organising the delivery of asthma care. There is need for quality research on organisational methods of delivery of asthma care that could be used to inform policy makers, in particular examining whether patients treated by healthcare professional with expertise and interest in asthma will experience better outcomes.

Full text

PDF
135

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander J. S., Younger R. E., Cohen R. M., Crawford L. V. Effectiveness of a nurse-managed program for children with chronic asthma. J Pediatr Nurs. 1988 Oct;3(5):312–317. [PubMed] [Google Scholar]
  2. Barnes G., Partridge M. R. Community asthma clinics: 1993 survey of primary care by the National Asthma Task Force. Qual Health Care. 1994 Sep;3(3):133–136. doi: 10.1136/qshc.3.3.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barritt P. W., Staples E. B. Measuring success in asthma care: a repeat audit. Br J Gen Pract. 1991 Jun;41(347):232–236. [PMC free article] [PubMed] [Google Scholar]
  4. Bell D., Layton A. J., Gabbay J. Use of a guideline based questionnaire to audit hospital care of acute asthma. BMJ. 1991 Jun 15;302(6790):1440–1443. doi: 10.1136/bmj.302.6790.1440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bryce F. P., Neville R. G., Crombie I. K., Clark R. A., McKenzie P. Controlled trial of an audit facilitator in diagnosis and treatment of childhood asthma in general practice. BMJ. 1995 Apr 1;310(6983):838–842. doi: 10.1136/bmj.310.6983.838. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bucknall C. E., Robertson C., Moran F., Stevenson R. D. Differences in hospital asthma management. Lancet. 1988 Apr 2;1(8588):748–750. doi: 10.1016/s0140-6736(88)91549-8. [DOI] [PubMed] [Google Scholar]
  7. Butz A. M., Malveaux F. J., Eggleston P., Thompson L., Schneider S., Weeks K., Huss K., Murigande C., Rand C. S. Use of community health workers with inner-city children who have asthma. Clin Pediatr (Phila) 1994 Mar;33(3):135–141. doi: 10.1177/000992289403300302. [DOI] [PubMed] [Google Scholar]
  8. Carswell F., Robinson E. J., Hek G., Shenton T. A Bristol experience: benefits and cost of an 'asthma nurse' visiting the homes of asthmatic children. Bristol Med Chir J. 1989 Feb;104(1):11–12. [PMC free article] [PubMed] [Google Scholar]
  9. Charlton I., Antoniou A. G., Atkinson J., Campbell M. J., Chapman E., Mackintosh T., Schapira D. Asthma at the interface: bridging the gap between general practice and a district general hospital. Arch Dis Child. 1994 Apr;70(4):313–318. doi: 10.1136/adc.70.4.313. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Charlton I., Charlton G., Broomfield J., Campbell M. An evaluation of a nurse-run asthma clinic in general practice using an attitudes and morbidity questionnaire. Fam Pract. 1992 Jun;9(2):154–160. doi: 10.1093/fampra/9.2.154. [DOI] [PubMed] [Google Scholar]
  11. Charlton I., Charlton G., Broomfield J., Mullee M. A. Audit of the effect of a nurse run asthma clinic on workload and patient morbidity in a general practice. Br J Gen Pract. 1991 Jun;41(347):227–231. [PMC free article] [PubMed] [Google Scholar]
  12. Clark N. M. Asthma self-management education. Research and implications for clinical practice. Chest. 1989 May;95(5):1110–1113. doi: 10.1378/chest.95.5.1110. [DOI] [PubMed] [Google Scholar]
  13. Colver A. F. Community campaign against asthma. Arch Dis Child. 1984 May;59(5):449–452. doi: 10.1136/adc.59.5.449. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Connett G. J., Warde C., Wooler E., Lenney W. Audit strategies to reduce hospital admissions for acute asthma. Arch Dis Child. 1993 Aug;69(2):202–205. doi: 10.1136/adc.69.2.202. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Crompton G. K., Grant I. W., Chapman B. J., Thomson A., McDonald C. F. Edinburgh Emergency Asthma Admission Service: report on 15 years' experience. Eur J Respir Dis. 1987 May;70(5):266–271. [PubMed] [Google Scholar]
  16. Dzyngel B., Kesten S., Chapman K. R. Assessment of an ambulatory care asthma program. J Asthma. 1994;31(4):291–300. doi: 10.3109/02770909409089476. [DOI] [PubMed] [Google Scholar]
  17. Ebden P., Carey O. J., Quinton D., Cookson J. B. A study of acute asthma in the accident and emergency department. Br J Dis Chest. 1988 Apr;82(2):162–167. doi: 10.1016/0007-0971(88)90037-x. [DOI] [PubMed] [Google Scholar]
  18. Fireman P., Friday G. A., Gira C., Vierthaler W. A., Michaels L. Teaching self-management skills to asthmatic children and their parents in an ambulatory care setting. Pediatrics. 1981 Sep;68(3):341–348. [PubMed] [Google Scholar]
  19. Fitzgerald J., Freund D. A., Hughett B., McHugh G. J. Influence of organizational components on the delivery of asthma care. Med Care. 1993 Mar;31(3 Suppl):MS61–MS73. doi: 10.1097/00005650-199303001-00009. [DOI] [PubMed] [Google Scholar]
  20. Greineder D. K., Loane K. C., Parks P. Reduction in resource utilization by an asthma outreach program. Arch Pediatr Adolesc Med. 1995 Apr;149(4):415–420. doi: 10.1001/archpedi.1995.02170160069010. [DOI] [PubMed] [Google Scholar]
  21. Henry R. L., Fitzclarence C. A., Henry D. A., Cruickshank D. What do health care professionals know about childhood asthma? J Paediatr Child Health. 1993 Feb;29(1):32–35. doi: 10.1111/j.1440-1754.1993.tb00436.x. [DOI] [PubMed] [Google Scholar]
  22. Henry R. L., Milner A. D. Specialist approach to childhood asthma: does it exist? Br Med J (Clin Res Ed) 1983 Jul 23;287(6387):260–261. doi: 10.1136/bmj.287.6387.260. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Hickman M., Drummond N., Grimshaw J. A taxonomy of shared care for chronic disease. J Public Health Med. 1994 Dec;16(4):447–454. doi: 10.1093/oxfordjournals.pubmed.a043026. [DOI] [PubMed] [Google Scholar]
  24. Hill R., Williams J., Britton J., Tattersfield A. Can morbidity associated with untreated asthma in primary school children be reduced?: a controlled intervention study. BMJ. 1991 Nov 9;303(6811):1169–1174. doi: 10.1136/bmj.303.6811.1169. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Hughes D. M., McLeod M., Garner B., Goldbloom R. B. Controlled trial of a home and ambulatory program for asthmatic children. Pediatrics. 1991 Jan;87(1):54–61. [PubMed] [Google Scholar]
  26. Integrated care for asthma: a clinical, social, and economic evaluation. Grampian Asthma Study of Integrated Care (GRASSIC) BMJ. 1994 Feb 26;308(6928):559–564. [PMC free article] [PubMed] [Google Scholar]
  27. Interiano B., Guntupalli K. K. Metered-dose inhalers. Do health care providers know what to teach? Arch Intern Med. 1993 Jan 11;153(1):81–85. doi: 10.1001/archinte.153.1.81. [DOI] [PubMed] [Google Scholar]
  28. Joe R. H., Kellermann A., Arheart K., Ellis R., Self T. Emergency department asthma treatment protocol. Ann Pharmacother. 1992 Apr;26(4):472–476. doi: 10.1177/106002809202600402. [DOI] [PubMed] [Google Scholar]
  29. Keeley D. How to achieve better outcome in treatment of asthma in general practice. BMJ. 1993 Nov 13;307(6914):1261–1263. doi: 10.1136/bmj.307.6914.1261. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Lipworth B. J., Allan J., Jackson C. M., Dhillon P. D., Winter J. H., Clark R. A. An audit of hospital discharge letters in patients admitted with acute asthma. Tayside Asthma Audit Group. Scott Med J. 1993 Aug;38(4):116–119. doi: 10.1177/003693309303800408. [DOI] [PubMed] [Google Scholar]
  31. Lipworth B. J., Jackson C. M., Ziyaie D., Winter J. H., Dhillon P. D., Clark R. A. An audit of acute asthma admissions to a respiratory unit. Health Bull (Edinb) 1992 Sep;50(5):389–398. [PubMed] [Google Scholar]
  32. Maiman L. A., Green L. W., Gibson G., MacKenzie E. J. Education for self-treatment by adult asthmatics. JAMA. 1979 May 4;241(18):1919–1922. [PubMed] [Google Scholar]
  33. Martys C. R. Asthma care in Darley Dale: general practitioner audit. BMJ. 1992 Mar 21;304(6829):758–760. doi: 10.1136/bmj.304.6829.758. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Mayo P. H., Richman J., Harris H. W. Results of a program to reduce admissions for adult asthma. Ann Intern Med. 1990 Jun 1;112(11):864–871. doi: 10.7326/0003-4819-112-11-864. [DOI] [PubMed] [Google Scholar]
  35. Mitchell E. A., Ferguson V., Norwood M. Asthma education by community child health nurses. Arch Dis Child. 1986 Dec;61(12):1184–1189. doi: 10.1136/adc.61.12.1184. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Modell M., Harding J. M., Horder E. J., Williams P. R. Improving the care of asthmatic patients in general practice. Br Med J (Clin Res Ed) 1983 Jun 25;286(6383):2027–2030. doi: 10.1136/bmj.286.6383.2027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Orton P. Shared care. Lancet. 1994 Nov 19;344(8934):1413–1415. doi: 10.1016/s0140-6736(94)90573-8. [DOI] [PubMed] [Google Scholar]
  38. Partridge M. R. Delivering optimal care to the person with asthma: what are the key components and what do we mean by patient education? Eur Respir J. 1995 Feb;8(2):298–305. doi: 10.1183/09031936.95.08020298. [DOI] [PubMed] [Google Scholar]
  39. Pearson M. G., Ryland I., Harrison B. D. National audit of acute severe asthma in adults admitted to hospital. Standards of Care Committee, British Thoracic Society. Qual Health Care. 1995 Mar;4(1):24–30. doi: 10.1136/qshc.4.1.24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Phin S., Oates R. K. Variations in the treatment of childhood asthma. Med J Aust. 1993 Nov 15;159(10):662–666. doi: 10.5694/j.1326-5377.1993.tb138080.x. [DOI] [PubMed] [Google Scholar]
  41. Sowden A. J., Sheldon T. A., Alberti G. Shared care in diabetes. BMJ. 1995 Jan 21;310(6973):142–143. doi: 10.1136/bmj.310.6973.142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Usherwood T. P., Barber J. H. Audit of process and outcome in a mini-clinic for children with asthma. Fam Pract. 1988 Dec;5(4):289–293. doi: 10.1093/fampra/5.4.289. [DOI] [PubMed] [Google Scholar]
  43. Usherwood T. P., Barber J. H. General practice audit of the care of children with asthma. Br Med J (Clin Res Ed) 1985 Jul 27;291(6490):254–254. doi: 10.1136/bmj.291.6490.254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Van Damme R., Drummond N., Beattie J., Douglas G. Integrated care for patients with asthma: views of general practitioners. Br J Gen Pract. 1994 Jan;44(378):9–13. [PMC free article] [PubMed] [Google Scholar]
  45. Weiss K. B., Budetti P. Examining issues in health care delivery for asthma. Background and workshop overview. Med Care. 1993 Mar;31(3 Suppl):MS9–M19. doi: 10.1097/00005650-199303001-00004. [DOI] [PubMed] [Google Scholar]

Articles from Quality in Health Care are provided here courtesy of BMJ Publishing Group

RESOURCES