title: Accessibility, clinical effectiveness, and practice costs of providing a telephone option for routine asthma reviews: phase IV controlled implementation study.
abstract: BACKGROUND
  Attendance for routine asthma reviews is poor. A recent randomised controlled trial found that telephone consultations can cost-effectively and safely enhance asthma review rates; however, concerns have been expressed about the generalisability and implementation of the trial's findings.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a telephone option as part of a routine structured asthma review service.
  
  
  METHODS
  Phase IV controlled before-and-after implementation study.
  
  
  METHODS
  A large UK general practice.
  
  
  METHODS
  Using existing administrative groups, all patients with active asthma (n = 1809) received one of three asthma review services: structured recall with a telephone-option for reviews versus structured recall with face-to-face-only reviews, or usual-care (to assess secular trends). Main outcome measures were: proportion of patients with active asthma reviewed within the previous 15 months (Quality and Outcomes Framework target), mode of review, enablement, morbidity, and costs to the practice.
  
  
  RESULTS
  A routine asthma review was provided for 397/598 (66.4%) patients in the telephone-option group compared with 352/654 (53.8%) in the face-to-face-only review group: risk difference 12.6% (95% confidence interval [CI] = 7.2 to 17.9, P<0.001). The usual-care group achieved a review rate of 282/557 (50.6%). Morbidity was equivalent in the three groups; however, enablement (P = 0.03) and confidence (P = 0.007) in asthma management were greater in the telephone-option versus face-to-face-only group. The cost per review achieved by providing the telephone-option service was lower than the face-to-face-only service (10.03 pounds versus 12.74 pounds, mean difference 2.71 pounds; 95% CI = 1.92 to 3.50, P<0.001); usual-care costs were 11.85 pounds per review achieved.
  
  
  CONCLUSIONS
  Routinely offering telephone reviews cost-effectively increased asthma review rates, enhancing patient enablement and confidence with management, with no detriment to asthma morbidity. Practices should consider a telephone option for their asthma review service.
authors.affiliation: Allergy and Respiratory Research Group, University of Edinburgh, Edinburgh. hilary.pinnock@ed.ac.uk
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
authors.forename: Lorraine
authors.initials: L
authors.lastname: Adlem
authors.forename: Suzanne
authors.initials: S
authors.lastname: Gaskin
authors.forename: Jan
authors.initials: J
authors.lastname: Harris
authors.forename: Caroline
authors.initials: C
authors.lastname: Snellgrove
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000191:economics / Q000628:therapy*; D002648:Child; D003266:Continuity of Patient Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D005194:Family Practice / Q000191:economics / Q000592:standards; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D019114:Remote Consultation / Q000191:economics / Q000592:standards*; D011795:Surveys and Questionnaires; D013689:Telephone; D006113:United Kingdom