title: Acute severe asthma: factors that influence hospital referral by the general practitioner and self-referral by the patient.
abstract: We describe a prospective study of 261 consecutive episodes of acute severe asthma occurring in 232 patients in 1 year. Sixty-seven episodes were treated at home by a selected group of 34 general practitioners, 148 episodes were treated in hospital following referral from general practitioners and 46 episodes were treated in hospital after self-referral, not having been seen by a general practitioner. All patients recovered fully. Comparisons between these groups of patients showed that those selected for hospital admission had higher pulse rates, lower peak expiratory flow rates and more severe grades of attack than those treated at home. Children were more likely to be admitted to hospital, as were patients living near to hospital, or those who were already receiving hospital outpatient supervision. There were self-referrals in all age groups. Several factors which influence the decision on admission, including the speed of onset and severity of the episode, justify some shift of the primary care role from the general practitioner to the hospital. If self-referral is to be encouraged there is a need for agreement on the types of patient and the nature of the attack that are best suited to this type of management.
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005194:Family Practice; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012017:Referral and Consultation; D012648:Self Care