Volume 19 Issue 1 March 2010Discussion Paper
Setting the standard for routine asthma consultations:
a discussion of the aims, process and outcomes of reviewing
people with asthma in primary care
Pages 75-83
*Hilary Pinnocka, Monica Fletcherb, Steve Holmesc, Duncan Keeleyd, Jane Leyshone, David Pricef, Richard Russellg, Jenny Versnelh, Bronwen Wagstaffi
a
Senior Clinical Research Fellow, Allergy and Respiratory Research Group, Centre of Population Health Sciences: GP Section, University of Edinburgh, Scotland, UK
b
Chief Executive, Education for Health, The Athenaeum, Warwick, UK
c
General Practitioner, The Park Medical Practice, Shepton Mallet, UK
d
General Practitioner, The Rycote Practice, East Street, Thame, UK
e
Team Leader: Respiratory & Asthma, Education for Health, The Athenaeum, Warwick, UK
f
Professor of Primary Care Respiratory Medicine, Centre of Academic Primary Care, University of Aberdeen; Foresterhill Health Centre, Westburn Road, Aberdeen, Scotland, UK
g
Honorary Clinical Senior Lecturer at the National Heart and Lung Institute, Imperial College, London, UK
h
Executive Director of Research and Policy, Asthma UK, London, UK
i
Policy Advisor, Primary Care Respiratory Society UK, Lockerbie, UK
Received 31 December 2008 • Accepted 18 November 2009 • Online 29 January 2010
Abstract
Globally, asthma morbidity remains unacceptably high. If outcomes are to be improved, it is crucial that routine review consultations in
primary care are performed to a high standard. Key components of a review include:
• Assessment of control using specific morbidity questions to elucidate the presence of symptoms, in conjunction with the frequency of
use of short-acting bronchodilators and any recent history of acute attacks
• After consideration of the diagnosis, and an assessment of compliance, inhaler technique, smoking status, triggers, and rhinitis,
identification of poor control should result in a step-up of treatment in accordance with evidence-based guideline recommendations
• Discussion should address understanding of the condition, patient-centred management goals and attitudes to regular treatment, and
should include personalised self-management education
Regular review of people with asthma coupled with provision of self-management education improves outcomes. Underpinned by a
theoretical framework integrating professional reviews and patient self-care we discuss the practical barriers to implementing guided selfmanagement
in routine clinical practice.
Keywords
Asthma, primary care, guided self-management, monitoring long-term conditions, asthma action plan
* Corresponding author. Hilary Pinnock Tel: +44 (0)131 650 8102 Fax: +44 (0)131 650 9119 Email: hilary.pinnock@ed.ac.uk | |
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