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Battling patients save a practice

Emma Wilkinson and Rob Finch report on research presented at last week's European Respiratory Society conference in Glasgow

GPs who carry out systematic audits of their asthma patients can transform the quality of care and halve the numbers suffering symptoms, new research concludes.

The results came as several large-scale studies criticised GPs for achieving only 'poor control' of asthma symptoms and failing to adhere to


Respiratory experts urged GPs to take a more proactive approach to treating asthma and said they often underestimated the extent of uncontrolled symptoms.

Researchers assessed the effect of structured audit on care of 19,000 patients. The audit questions aimed to uncover poor symptom control and failure to treat according to guidelines.

After guideline-based treatment, the proportion of symptom-free patients rose from 23 to 40 per cent for daytime symptoms, 45 to 66 per cent for night-time symptoms and 28 to 47 per cent for symptoms during exercise.

Co-author Gaylor Hoskins, a research fellow at the Tayside centre for general practice, University of Dundee, said: 'It's about encouraging a

better quality of consultation. We have to stop being com-placent.'

But she also presented results of a second study of standard GP care that showed 'poor control is apparent in patients throughout the severity spectrum of asthma'.

An analysis of almost 60,000 patients from more than 1,000 GP practices found 35 per cent experienced symptoms on a daily basis and another 27 per cent once or twice a week.

A quarter of patients were poorly compliant with medication and more than a third were overusing short-acting ß2-agonists.

Dr Mike Thomas, General Practice Airways Group clinical research fellow at the University of Aberdeen and a GP in Michinhampton, Gloucestershire, said GPs tended to think asthma was well controlled but the evidence suggested otherwise.

'We need to be giving proactive rather than reactive care,' he said, adding that GPs should do an audit of asthma patients to identify which were not being managed appropriately.

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