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. 2001 Oct 27;323(7319):962. doi: 10.1136/bmj.323.7319.962

Box 4.

: Access to care during asthma attacks and practices' asthma strategies

  • Patients experiencing easy access to primary care
  • Doctor and practice nurse develop partnership with patient
  • “We [the practice nurse and GP] work with her.”
  • General practitioner of 60 year old white woman (a)
  • Doctor describes partnership with patient and provides privileged access
  • “[She] would not see any doctor. I say, ‘Anytime you’ve got a problem with your breathing, coughing, whatever, you ring me anytime, and I'll pop in to see you. Even if I'm not on duty I'll see you.' Gave her all the talks about asthma, literature about asthma, things about asthma, inhaler technique, checking peak flow. Gave her a peak flow meter she monitors. Tell her about the danger signals, about asthma, what she should ask for medical-wise . . . She has a nebuliser at home, [which] has stopped few referrals to the casualty and few 999 calls. Given a course of steroids, which leave at the house in case. If she starts, she needs to start, so I just give her one dose, ‘So you start it by the time I see you, because I don’t want you to wait for appointment.' ”
  • General practitioner of 20 year old white woman
  • Systematic approach targeting high risk patient to prevent admission
  • “It's impossible to have a structured approach with her, but that's what we've tried to do . . . She's unmanageable otherwise. We don't want her to go back into hospital, so one of the partners says, ‘It’s my turn to take her on,' so they would visit her regularly to pre-empt hospital admission.”
  • General practitioner of 50 year old white woman
  • “I've got three GPs. [They're] marvellous.”
  • They're good? “Yes.”
  • You're very happy with them? “I can't fault them.”
  • 50 year old white woman
  • Patients experiencing difficult access to primary care
  • Doctor declines to see patient and writes prescription instead
  • “No, the doctor is moody, sometimes he says come and other times not. My husband says, ‘What kind of doctor is he?’ The doctor said, ‘We do not have an appointment, but I will write a prescription.’ ”
  • 34 year old Gujarati Muslim woman
  • Receptionist prevents access to general practitioner, out of hours service asks child to arrange ambulance
  • “I said to the secretary, ‘Let me speak to the doctor.’ She said the doctor is busy. I told her this was the problem and maybe he give the right medicine. Maybe she told the doctor what the problem was. The prescription was already written for me. I showed the prescription to the doctor. I told him, ‘I have an asthma attack—I feel it might come on—I already have the flu.’ I knew it was not right, not seeing my doctor. I found it difficult to control my breathing. I kept ringing every half an hour. Then I told the child to ring the emergency doctor. He said, ‘There is no reason to come, I will not be able to find the right medicines for you so ring the emergency and go to hospital.’ ”
  • 45 year old Pakistani Muslim man
  • Asthma not prioritised, patients not targeted
  • Self management plans—do you use those very much for your patients? “Something I push for diabetes, but not for asthma.”
  • Do you have any particular patients that you regard as high risk, that are different from your other patients? “Not high risk, no.”
  • General practitioner of 34 year old Gujarati Muslim woman
  • Patients going directly to hospital, or lay mediated referral to hospital
  • Rapid attention from hospital staff
  • “You get full attention once you come in [to hospital] with the breathing. You know you don't wait about anywhere. You're in—boomf—and you're sorted. It's wonderful.”
  • 65 year old white man (b)
  • Experience of slow response by general practitioner
  • “The GP actually takes a long time to deal with it. If I thought the GP was going to be quicker and they were able to deal with it better, I would have called them, I don't really like to come into hospital . . . I had a kidney stone last year, and I phoned the GP to come . . . After three hours they had not returned the call, so I called the ambulance . . . If you are going to wait three hours and you are having an asthma attack, you could not possibly do that.”
  • 45 year old white woman (a)