The impact of a mass communications campaign on the reported management of asthma by general practitioners

How well do doctors know their patients with severe asthma?

BACKGROUND

Rates of asthma mortality have fallen in Australia since the commencement of the National Asthma Campaign and promotion of the Australian asthma management plan. New strategies are now needed to further reduce mortality.

AIM

To examine agreement about key features between asthma patients and their general practitioners (GPs).

METHODS

We interviewed: (i) the next of kin of 56 asthma deaths, (ii) 91 asthma patients presenting to emergency departments with acute severe asthma and (iii) 147 of their GPs.

RESULTS

Agreement was substantial for usage of oral symptomatic medication, but poor for inhaled symptomatic and preventive medications. There was moderate agreement regarding hospital admissions within the last 12 months among the cases, but little about other markers of severity. There was moderate agreement where the presenting or fatal attack was triggered by an upper respiratory-tract infection or aspirin. The next of kin and GPs agreed about family problems, but not about other psychosocial issues. They also agreed about which cases had been given action plans or verbal instructions, but few other aspects of asthma management. There was also moderate agreement regarding the use of peak flow meters by the controls.

CONCLUSIONS

Doctors often have relatively poor insights into self-management practices, social background or trigger factors, even in high-risk patients. This should be considered when planning future campaigns to improve asthma management and further reduce mortality.

Beliefs that support the behavior of people with asthma: a qualitative investigation

Differences between patients' knowledge and behavior in relation to asthma may account for continuing morbidity in theface of professional and public asthma education campaigns. We conducted a qualitative study of beliefs that support asthma-related behavior, obtaining data from interviews with 70 adult patients. Analysis identified four clear subgroups, or "streams," of adults with asthma: an "anonymous" stream, who doubt that they have asthma and manage symptoms outside the organized health system; an "isolated" stream, who feel dependent on bronchodilators and do not understand the potential of preventive therapy; a "suboptimal" stream, who are confident that they are managing their asthma effectively but who are excessively reliant on bronchodilators; and an "optimal stream," who have high expectations of outcomes and participate actively in a partnership with a doctor. Characteristics of the doctor and the doctor-patient relationship are important elements in altering asthma-related behavior in ways that may facilitate the best health outcomes.

Reported use of asthma management plans in South Australia

OBJECTIVE

To examine the use of asthma management plans (AMPs) and specific elements of AMPs in a South Australian community.

DESIGN

Cross-sectional questionnaire survey by experienced interviewers.

PARTICIPANTS AND SETTING

307 adults with current asthma, confirmed by a doctor, who were among 3001 respondents of a representative sample of 4065 South Australian adults recruited by multistage systematic clustered area sampling for a larger study in March 1995.

MAIN OUTCOME MEASURES

Prevalence of reported use of AMPs and of specific elements of AMPs, such as knowledge of trigger factors and having an action plan, and the proportion of adults with asthma receiving what we defined as "good management".

RESULTS

46% reported having an AMP; 63% had discussed trigger factors with their doctors and 39.5% had action plans. 82% had been told the severity of their asthma, and 23.3% were receiving good management.

CONCLUSION

Less than half of people with asthma use AMPs, although certain elements within the AMPs are reportedly being used more frequently. More research is required on why AMPs are not more generally used and, more importantly, on what elements within the AMP model are useful and effective for people with asthma and likely to be used by their general practitioners (GPs).

Asthma management in eastern Australia, 1990 and 1993

OBJECTIVE

To compare the prevalence and management of asthma before and after institution of the National Asthma Campaign.

DESIGN

Repeat population-based cross-sectional analytic surveys.

SETTING

Eastern Australia (Sydney, Brisbane, Melbourne, and the Hunter Valley, New South Wales) in September 1990 and 1993.

SUBJECTS

Primary school children and their parents from 33 schools (8746 children) in 1990 and 40 schools (10 106 children) in 1993.

OUTCOME MEASURES

Frequency of respiratory symptoms; diagnoses of asthma; medications; lung function measurements; possession of a peak flow meter and a written action plan.

RESULTS

Age and sex distribution of the subjects and the reported prevalence of asthma were similar in 1990 and 1993. The frequency of reported episodes of wheezing and troublesome cough increased significantly in children between 1990 and 1993. Asthma management improved in accordance with current recommendations, with significantly decreased use of regular inhaled bronchodilator medication in children and increased use of preventive medication, monitoring of lung function by doctors and use of peak flow meters and written action plans in both children and adults.

CONCLUSION

There is evidence that the National Asthma Campaign may have contributed to increased awareness and improved management of asthma in children and adults in eastern Australia.

Asthma management and morbidity in Australian general practice: the relationship between patient and doctor estimates

The aims of this study were to describe asthma management and morbidity in patients attending general practitioners in Australia, and to assess the relationship between patient reports and those of their general practitioner (GP). The sample comprised consecutive patients attending 46 general practitioners chosen at random in five regions of New South Wales, Australia. A total of 4538 patients were screened, 607 (13.4%) reported ever having diagnosed asthma, and the 501 who reported asthma in the previous 12 months completed a detailed questionnaire. Three hundred and thirty-four patients also had information about their asthma management recorded by their GP. The patient questionnaire asked about asthma symptoms, therapy, lung function measurement, and asthma-related morbidity. The GP questionnaire asked the doctor to record similar information about the patients. Two-thirds of the patients used regular inhaled beta 2-agonist medication, and one-half reported using preventive therapy. Only 24% owned a peak flow meter and 9% had a written plan of action for asthma attacks. Although preventive therapy and airway function assessment were more common in those with frequent symptoms (> 2-3 times per week), this group were still sub-optimally managed. In the matched sample (n = 334), doctors reported prescribing bronchodilator and preventive medication, measuring airway function and recommending peak flow meter use more often than suggested by patient-reported data. The study concludes that many patients do not attend for regular review, and that management remains sub-optimal, particularly in young adults. Data from patient surveys may underestimate clinical practice, as assessed from doctors' records. This should lead to patient-derived estimates of management being interpreted with caution in epidemiological studies. Further attention to patient understanding and compliance with prescribed asthma management advice is needed in order to better manage asthma in the community.