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GP asthma registers ‘reduce costs’

At-risk registers of vulnerable patients with asthma in general practice reduce hospital admissions by half compared with routine care, a UK study suggests.

A study of 29 GP practices – 15 of which implemented an electronic system to flag up at-risk patients – showed the strategy cut the risk of hospitalisation by half compared with routine asthma care.

There was also a non-significant drop in patients using A&E and out-of-hours services compared with those receiving routine care.

Those on the at-risk register – because they had severe asthma plus psychosocial factors such as smoking, obesity, poor adherence or learning difficulties – were also significantly less likely to receive nebulised ß-agonists than patients receiving routine care. And they were also prescribed significantly more long-acting ß-agonists than with those receiving routine care, the researchers said.

Although no difference was found in overall asthma exacerbations compared with routine care, the researchers said the risk register system had seemingly reduced ‘crises' for the most severe patients.

Costs for asthma treatment for all practices rose over the study period, but those with at-risk registers saved more money than those receiving routine care, despite having to fork out for the alert system and training for staff.

Even with a cost of £52 per patient on setting the system up, intervention practices spent £138.21 less per patient over 12 monthsthan those providing routine care, the analysis showed.

And general feedback from staff was that the scheme did not increase their workload.

The researchers, from the University of East Anglia, concluded: ‘Use of asthma risk registers is mentioned in British asthma guidelines and this study is the first to detail how they can be implemented and provide reliable, generalisable evidence on their potential benefit.

‘The overall pattern of results suggests that use of asthma risk registers improved patient management and outcomes.'

Thorax 2012, online 31 August


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