Does participation in distance learning and audit improve the care of patients with acute asthma attacks? The General Practitioners in Asthma Group.
OBJECTIVE
To test whether general practitioners who completed an audit cycle encompassing a data recording exercise, distance learning programme and personalized feedback changed their management of patients with acute asthma attacks.


METHODS
Practice and patient details from two national correspondence surveys of the management of acute asthma attacks in the United Kingdom in 1991-92 and 1992-93 were compared. Main outcome measures were use of nebulised bronchodilators, systemic steroids during an asthma attack, and increased use of prophylactic therapy after attacks.


RESULTS
Ninety-one general practitioners completed an audit cycle and reported data on 782 patients with asthma attacks in 1991-92 and 669 in 1992-93. There were no significant changes in practice resources during this time. Management changed in line with recommended guidelines and audit feedback suggestions leading to more use of nebulised bronchodilators [272 (35%) before, 268 (40%) after, Odds Ratio (OR) 0.80, 95% Confidence Intervals (CI) 0.64-0.99], systemic steroids [563 (72%) before, 506 (76%) after, OR 0.83, CI 0.65-1.06], and 'step-up' in preventative therapy [402 (51%) before, 382 (57%) after, OR 0.79, CI 0.64-0.98].


CONCLUSIONS
General Practitioners who completed an audit cycle showed changes in the management of acute asthma attacks in line with guidelines which may have been caused by participation in distance learning and clinical audit. However, general practitioners motivated to change clinical management may be similarly motivated to take part in audit. Audit may be the catalyst for change rather than the cause of change.
Hoskins
G
G
Neville
R G
RG
Smith
B
B
Clark
R A
RA
D000208:Acute Disease; D001249:Asthma / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004502:Education, Medical, Continuing / Q000379:methods; D006801:Humans; D008485:Medical Audit; D010821:Physicians, Family / Q000193:education*; D016896:Treatment Outcome; D006113:United Kingdom
D001993:Bronchodilator Agents