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Clinical Trial
. 2007 Sep;57(542):714-22.

Accessibility, clinical effectiveness, and practice costs of providing a telephone option for routine asthma reviews: phase IV controlled implementation study

Hilary Pinnock  1 , Lorraine Adlem, Suzanne Gaskin, Jan Harris, Caroline Snellgrove, Aziz Sheikh
Affiliations
Clinical Trial

Accessibility, clinical effectiveness, and practice costs of providing a telephone option for routine asthma reviews: phase IV controlled implementation study

Hilary Pinnock et al. Br J Gen Pract. 2007 Sep.

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.

Aim: To evaluate the effectiveness of a telephone option as part of a routine structured asthma review service.

Design of study: Phase IV controlled before-and-after implementation study.

Setting: A large UK general practice.

Method: 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.

Conclusion: 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.

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Figures

Figure 1
Figure 1
Flow of patients through the study.
Figure 2
Figure 2
Cumulative proportion of patients reviewed in the three groups on a monthly basis.
See this image and copyright information in PMC

References

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