title: Is the quality of asthma prescribing, as measured by the general practice ratio of corticosteroid to bronchodilator, associated with asthma morbidity?
abstract: The objective of this study was to determine whether the quality of asthma prescribing in general practice is associated with the severity of asthma patients' symptoms. Cross-sectional survey of asthma-like symptoms in patients prescribed antiasthma therapy was used. The setting was two general practices with contrasting ratios of corticosteroid to bronchodilator (high vs. low). The main outcome measures were: patient symptoms score and patient characteristics (age, gender, diagnosis, smoking, social class, and deprivation status). Patients on antiasthma therapy from the practice with the low corticosteroid to bronchodilator ratio had a higher mean symptom score (20.1, 95% CI 18.6, 21.7) than patients on antiasthma therapy from the practice with the high corticosteroid to bronchodilator ratio (13.2, 95% CI 11.8, 14.5). The mean difference in patient symptom score between the two practices was 7.0 (95% CI 4.9, 9.0); this changed little after adjustment for potential confounders. The quality of prescribing, as measured by the practice ratio of corticosteroid to bronchodilator, appears to be an important factor in the outcome of asthma care. The ratio of corticosteroid to bronchodilator in a general practice is one indicator of the quality of prescribing for asthma.
authors.affiliation: Primary Care Sciences Research Centre and Industrial and Community Health Research Centre, School of Postgraduate Medicine, Keele University, North Staffordshire Medical Institute, Hartshill Road, ST4 7NY, Stoke-on-Trent, UK. pma03@keele.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Shelley
authors.forename: P
authors.initials: P
authors.lastname: Croft
authors.forename: S
authors.initials: S
authors.lastname: Chapman
authors.forename: C
authors.initials: C
authors.lastname: Pantin
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents