REDUCING ASTHMA MORBIDITY IN THE COMMUNITY - THE EFFECT OF A TARGETEDNURSE-RUN ASTHMA CLINIC IN AN ENGLISH GENERAL-PRACTICE

Although most primary health care teams in the U.K. now offer proactiv e care for patients with asthma, there is relatively little published evidence showing the effectiveness of such innovations. This may be du e in part to lack of targeting of extra care towards those most in nee d. Therefore, to demonstrate the benefits of targeted nurse-run asthma clinic care in a seven-partner general practice in a mixed urban and rural area of North Lincolnshire in the east of England, a cohort of 1 73 patients, with asthma selected predominantly by having high morbidi ty in a postal survey, completed 12 months follow-up in a nurse-run as thma clinic. A longitudinal comparison was conducted in terms of: chan ges in morbidity index category, inhaler technique score, knowledge sc ore, use of inhaled steroids, use of salmeterol, method of administrat ion of beta(2)-agonist medication and frequent use of peak flow meters . The number with high morbidity fell from 123 (71.1%) at the initial consultation to 14 (8.1%) at the 12-month review. Those with full mark s on inhaler technique rose from 28 (16.2%) to 142 (82.1%), and with f ull marks on asthma knowledge rose from 7 (4.0%) to 98 (56.6%). The nu mbers of patients using inhaled steroids and salmeterol rose from 127 (73.4%) to 171 (98.9%) and from 5 (2.9%) to 35 (20.2%), respectively, The preferred inhaler device for beta(2)-bronchodilator medication cha nged from metered dose aerosol to dry powder. Regular use of peak flow meters in 157 subjects aged 5 years and over rose from 43 (27.4%) to 116 (73.9%). These data clearly demonstrate the benefits of targeted p roactive nurse-run asthma care in terms of reduced morbidity for patie nts. The authors recommend the morbidity index targeting concept to ot her primary health care teams.