INTEGRATED CARE FOR ASTHMA - MATCHING CARE TO THE PATIENT

The purpose of the present study was to investigate whether criteria a ssociated with assignment of asthma patients between general practice (GP) care alone, integrated care (shared between GP care and hospital clinic) or conventional specialist review could be identified, and whe ther outcomes for these patients differed over the next 12 months. Sev en hundred and sixty four patients with a diagnosis of asthma and prev iously assigned to either integrated care or clinic care were reviewed after 1 year and reassigned, These patients were then followed for an other 12 months and clinical data were collected over this time. After 12 months in clinic care or integrated care, assignment to integrated care was predicted by previous participation in integrated care (OR 2 .94), patient preference for integrated care (OR 3.7), no admission (O R 1.56), fewer steroid courses during the previous year (OR 0.88) and nonattendance at review (OR 0.43) in the previous 12 months, Patient d ischarge to GP care was predicted by higher level of forced expiratory volume in one second (FEV(1)) (OR 1.49), lower number of GP consultat ions for troublesome asthma (OR 0.78), and nonattendance for review in the preceding year (OR 2.15), In the following 12 months, the three g roups of patients differed significantly in hospital admissions (Disch arged=0.008; Integrated=0.12; Clinic=0.31), bronchodilators prescribed (Discharged=8.5; Integrated=10.2; Clinic=13.9), GP consultations (Dis charged=1.3; Integrated=3.0; Clinic=4.1) and oral steroid courses (Dis charged=0.62; Integrated=1.7; Clinic=2.4). Patients assigned to integr ated care, clinic care or discharged to general practice care form thr ee distinct patient populations differing retrospectively and prospect ively in morbidity and admission risk. In particular, patients assigne d to integrated care fall midway in risk and morbidity between those d ischarged or those retained in clinic care. These results suggest that integrated care provides general practitioners with a system of manag ement for asthma patients, for whom they do not wish frequent speciali st review but who they do not believe can safely be discharged to gene ral practice care only. (C)ERS Journals Ltd 1996.