Organisation of asthma care: what difference does it make? A systematic review of the literature.
OBJECTIVE
To evaluate the effectiveness of different forms of organisation (delivery) of asthma care.


METHODS
A systematic review of the published evidence of effectiveness organisational methods of asthma management. Searches on computerised databases including Medline, CINAHL, and HELMIS, and relevant citations and letters to experts were used to identify relevant studies.


RESULTS
27 studies were identified that evaluated different organisational methods of delivery across both primary and secondary sectors, such as shared care, general practice asthma clinics, outpatient programmes, inpatient admissions policies, and the use of specialists. Only one third of the studies used a randomised controlled trial and many had small sample sizes. No conclusive evidence was found to favour any particular organisational form, although limited evidence would suggest that specialist care is better than general care and that shared care can be as effective as hospital led care.


CONCLUSIONS
There is little good published research evaluating different ways of organising the delivery of asthma care. There is need for quality research on organisational methods of delivery of asthma care that could be used to inform policy makers, in particular examining whether patients treated by healthcare professional with expertise and interest in asthma will experience better outcomes.
Eastwood
A J
AJ
NHS Centre for Reviews and Dissemination, University of York.
Sheldon
T A
TA
D006801:Humans; D000553:Ambulatory Care / Q000458:organization & administration; D001249:Asthma / Q000628:therapy; D003695:Delivery of Health Care / Q000458:organization & administration; D006302:Health Services Research; D006760:Hospitalization; D011050:Policy Making; D013222:State Medicine; D016896:Treatment Outcome; D006113:United Kingdom; D016032:Randomized Controlled Trials as Topic