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At the heart of general practice since 1960

Asthma registers call

By Daniel Cressey

A practice register of vulnerable asthma patients significantly benefits their health, new GP research reports.

The study, published in the Primary Care Respiratory Journal, found that placing patients on an at-risk register reduced their requirement for oral steroids and unplanned care.

The General Practice Airways Group, which requested addition of at-risk registers to the QOF during the recent review, urged all GPs to consider introducing them.

GP-led researchers at a Norfolk practice compared the health of 26 patients placed on an at-risk asthma register and 26 controls in the year before and year after its introduction.

After bringing in the register ­ which raised awareness of the patients' status by flagging them up ­ many of the health differences between the two groups disappeared.

In at-risk patients, the number of GP contacts fell from 16 to six and out-of-hours contacts from six to two, with differences from controls ceasing to be significant.

The number of courses of oral steroids prescribed to patients on the register fell from 14 to seven, with the difference with controls now only of

borderline significance.

There were also falls in hospital admissions and accident and emergency attendance, although numbers were too small for statistical analysis.

Study leader Dr Michael Noble, a GP in Acle, Norfolk, said: 'Our findings suggest implementation of an at-risk as-

thma register in primary care was a simple, low-cost intervention ­ an initial cost of £17 per patient.

'It largely reduced emergency treatments and service use among at-risk asthma patients to levels seen among matched controls.'

Dr Iain Small, chair of

the General Practice Airways Group's education committee and a GP in Peterhead, Aberdeenshire, said: 'GPs should consider setting up at-risk

registers of patients who are

at risk of significant destab-


He added that the group continued to want changes to the QOF. 'There are a number of issues about the asthma QOF ­ to modify or improve it certainly would be valuable.'

Criteria for register

· Severe asthma ­ BTS step

4 or 5 and/or hospital


· Other psychosocial difficulties

­ unemployment, single parenthood etc

· Psychiatric problems

· Evidence of poor control ­ based on medication use, frequent exacerbations, symptoms or peak flow

· Poor adherence

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