[Asthma management at the interface of general practice and hospital care].
The aim of the study was to assess the management of patients hospitalised for asthma with regard to the recommendations of the German Airway League, and the communication between hospital doctors and general practitioners (GPs). All records of patients discharged with asthma or COPD (ICD9) between 1/1996 and 6/1998 were retrieved (n = 169) in one general hospital. All patients whose asthma had been known in admission and was given as a reason for hospitalisation in the discharge letter were selected (n = 93). Treatment prescribed by the patients' GPs before hospitalisation as well as diagnostic procedures and treatment in hospital and the recommendations in the discharge letter were reviewed. Additionally the GPs were questioned with case vignettes. Before hospitalisation, most patients had been treated with theophyllin (66 %) and inhaled betamimetics (62 %), only 44 % had received topical and 29 % oral steroids by their GP. In hospital, lung function assessment was performed in only 8 % of the patients and there was no monitoring of the peak flow. The most commonly prescribed drugs were theophyllin (94 %), mucolytics (94 %) and antibiotics (82 %). Half of the patients (47 %) were discharged without adequate anti-inflammatory baseline treatment. The discharge letters did not contain detailed recommendations on future asthma management. There seems to be room for improvement with regard to the implementation of the German Airway League's recommendations both in hospital and in general practice: Few patients received systemic or inhaled steroids, whereas theophyllin and antibiotics were prescribed routinely. In hospital, airway obstruction was neither measured initially nor monitored. Communication between hospital doctors and GPs seems to be insufficient.
Hummers-Pradier
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Abteilung Allgemeinmedizin, Universität Göttingen. ehummer@gwdg.de
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000628:therapy*; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011785:Quality Assurance, Health Care; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016896:Treatment Outcome