title: Setting the standard for routine asthma consultations: a discussion of the aims, process and outcomes of reviewing people with asthma in primary care.
abstract: Globally, asthma morbidity remains unacceptably high. If outcomes are to be improved, it is crucial that routine review consultations in primary care are performed to a high standard. Key components of a review include: * Assessment of control using specific morbidity questions to elucidate the presence of symptoms, in conjunction with the frequency of use of short-acting bronchodilators and any recent history of acute attacks * After consideration of the diagnosis, and an assessment of compliance, inhaler technique, smoking status, triggers, and rhinitis, identification of poor control should result in a step-up of treatment in accordance with evidence-based guideline recommendations * Discussion should address understanding of the condition, patient-centred management goals and attitudes to regular treatment, and should include personalised self-management education Regular review of people with asthma coupled with provision of self-management education improves outcomes. Underpinned by a theoretical framework integrating professional reviews and patient self-care we discuss the practical barriers to implementing guided selfmanagement in routine clinical practice.
authors.affiliation: Senior Clinical Research Fellow, Allergy and Respiratory Research Group, Centre of Population Health Sciences: GP Section, University of Edinburgh, Scotland, UK. hilary.pinnock@ed.ac.uk
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
authors.forename: Monica
authors.initials: M
authors.lastname: Fletcher
authors.forename: Steve
authors.initials: S
authors.lastname: Holmes
authors.forename: Duncan
authors.initials: D
authors.lastname: Keeley
authors.forename: Jane
authors.initials: J
authors.lastname: Leyshon
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.forename: Richard
authors.initials: R
authors.lastname: Russell
authors.forename: Jenny
authors.initials: J
authors.lastname: Versnel
authors.forename: Bronwen
authors.initials: B
authors.lastname: Wagstaff
mesh_terms: D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D055317:Evidence-Based Practice; D006801:Humans; D055118:Medication Adherence; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D012307:Risk Factors
chemical_list: D001993:Bronchodilator Agents