COMPARISON OF THE PROCESS OF CARE OF ACUTE SEVERE ASTHMA IN ADULTS ADMITTED TO HOSPITAL BEFORE AND 1 YR AFTER THE PUBLICATION OF NATIONAL GUIDELINES

This study set out to assess the effect of publication of the British Guidelines on Asthma Management on the processes and outcomes of the i npatient care of acute severe asthma in the U.K. A criterion-based aud it of all acute asthma admissions during August and September 1990 (im mediately before) and in 1991 (1 yr after publication of the Guideline s) using eight criteria of process and outcome was performed. Thirty-s ix teaching and district general hospitals in England, Scotland and Wa les took part. In total, 766 patients admitted in 1990, and 900 patien ts admitted in 1991, were studied. The 1990 and 1991 cohorts were very similar demographically and had asthma of comparable severity. Respir atory physicians achieved similar high performance rates of between 75 and 91% for seven of the eight criteria for both years. Respiratory p hysicians were significantly more likely to provide patients with a wr itten management plan in 1991. General physicians' performance was sig nificantly lower in both years, but overall there was a very small, bu t just significant, improvement in their performance in 1991. Some hos pitals performed consistently well in both years. It is concluded that respiratory physicians consistently provide better asthma care than g eneral physicians. Though statistically significant, the small degree of improvement was disappointing. Possible reasons include: insufficie nt time for the Guidelines to be incorporated into practice; inaccessi bility of the Guidelines to general physicians; failure to accept resp onsibility for implementing the good practice reflected in the Guideli nes; and an explicit need for strategies to implement the Guidelines b eyond publication in a widely-read general medical journal.