Specialist care cuts asthma emergencies
16 January 2004

Specialist asthma support in GP surgeries can help to streamline use of health services and reduce asthma emergencies, according to new research funded by the National Asthma Campaign. However, patients benefited from the support to different extents, largely depending on their ethnicity.

Dr Chris Griffiths led a year-long study of 324 people with acute asthma from 44 general practices in the London boroughs of Newham and Tower Hamlets, near Tower Bridge, areas that are ethnically diverse with high levels of poverty.

Half of the patients in the group were South Asian, one-third were white and the balance of participants were African and Afro-Caribbean. Research has shown that in the UK people with asthma from minority or disadvantaged groups are more likely to experience worse symptoms.

Specialist asthma nurses visited all of the surgeries in the study giving different levels of support. In half of the practices, the nurses carried out reviews that included giving patients advice on self-management, a peak flow meter, a written asthma plan, oral steroids for emergency use, and instructions on when to use them. Patients who didn't speak English were given instructions through an interpreter. The health professionals at these surgeries also received two visits from the specialist nurses, who gave guidelines for identifying and managing patients with high-risk asthma.

The other half of surgeries in the study received only single visits from a specialist nurse, and standard asthma guidelines. Their patients were checked for inhaler technique but received no other specialist care.

Twelve months later, assessment of participants showed that those who had been given specialist care were far less likely to have to visit the doctor for emergency treatment for asthma than those from the surgeries who had received only basic specialist guidance, and were slightly less likely to be admitted to hospital with asthma symptoms. In addition, results also showed that white patients needed less care than the participants from other ethnic groups.

'This shows that a "one size fits all" approach to health care does not work for everyone,' said Philippa Major, the Campaign's assistant director of research. 'Different patients respond very differently to the same treatment, and health services must take the needs of local people into account when planning their provision of care.

'However, this study is further evidence that overall, interventions such as targeted specialist support in asthma care are not only cost effective for healthcare providers, but are also beneficial for people with asthma themselves.'