title: The facilitator effect: results from a four-year follow-up of children with asthma.
abstract: BACKGROUND
  A long-term evaluation of the process and outcomes of primary and secondary care is required to establish whether audit facilitators can improve the care of childhood asthma.
  
  
  OBJECTIVE
  To examine the long-term effect of an intervention by an audit facilitator on the management of children with asthma, and to investigate the implications for health service costs.
  
  
  METHODS
  A 4-year follow up was conducted of an intervention and control group totalling 2557 children aged 1-15 years from 12 general practices in the Tayside region. Primary care consultations, prescriptions, hospital contacts and health service costs 1 year before and 3 years after a facilitator visited practices were recorded. The facilitator encouraged the diagnosis and treatment of childhood asthma in the intervention group.
  
  
  RESULTS
  Favourable changes in consultation patterns, prescriptions and reduced hospital admissions seen during the intervention year did not persist in subsequent years. Two and three years after the facilitator visit the process and outcome of care was similar in both groups. The reduction in health service costs seen in the intervention group was equivalent to the cost of employing a facilitator.
  
  
  CONCLUSIONS
  The effect of a facilitator lasts only for the period of intervention. Enthusiasts will say that improving patient care without increasing health service costs justifies the widespread deployment of facilitators. Others more interested in long-term outcomes may disagree.
authors.affiliation: Tayside Centre for General Practice, University of Dundee.
authors.forename: C
authors.initials: C
authors.lastname: McCowan
authors.forename: R G
authors.initials: RG
authors.lastname: Neville
authors.forename: I K
authors.initials: IK
authors.lastname: Crombie
authors.forename: R A
authors.initials: RA
authors.lastname: Clark
authors.forename: F C
authors.initials: FC
authors.lastname: Warner
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000517:prevention & control*; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D003253:Consultants; D004739:England; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit / Q000191:economics; D010043:Outcome and Process Assessment, Health Care; D011787:Quality of Health Care