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. 2024 May 30;74(743):e355-e363.
doi: 10.3399/BJGP.2023.0214. Print 2024 Jun.

Post-hospitalisation asthma management in primary care: a retrospective cohort study

Dhanusha Punyadasa  1 , Nikita Simms-Williams  1 , Nicola J Adderley  1 , Rasiah Thayakaran  1 , Adel H Mansur  2 , Krishnarajah Nirantharakumar  1 , Prasad Nagakumar  3 , Shamil Haroon  1
Affiliations

Post-hospitalisation asthma management in primary care: a retrospective cohort study

Dhanusha Punyadasa et al. Br J Gen Pract. .

Abstract

Background: Clinical guidelines recommend that patients admitted to hospital for asthma attacks are reviewed in primary care following hospital discharge.

Aim: To evaluate asthma management in primary care following a hospital admission for asthma and its associations with patient characteristics.

Design and setting: A retrospective cohort study using English primary care data from the Clinical Practice Research Datalink Aurum database and linked Hospital Episode Statistics Admitted Patient Care data.

Method: Patients with asthma aged ≥5 years who had at least one asthma-related hospital admission from 1 January 2017 to 31 December 2019 were included. The primary outcome was a composite of any of the following delivered in primary care within 28 days from hospital discharge: asthma review, asthma management plan, asthma medication prescriptions, demonstration of inhaler technique, or smoking cessation counselling. The association between patient characteristics and delivery of clinical care was assessed using logistic regression.

Results: The study included 17 457 patients. A total of 10 515 (60.2%) patients received the primary outcome within 28 days of hospital discharge. There were 2311 (13.2%) who received an asthma review, 1459 (8.4%) an asthma management plan, 9996 (57.3%) an asthma medication, 1500 (8.6%) a demonstration of inhaler technique, and 52 (1.2% of smokers) had smoking cessation counselling. Patients from Black ethnic minority groups received less of this care (27%-54% lower odds, depending on age). However, short-acting bronchodilator prescriptions in the previous year were associated with an increased likelihood of the primary outcome.

Conclusion: A significant proportion of patients do not receive timely follow-up in primary care following asthma-related admissions to hospital, particularly among Black ethnic minority groups.

Keywords: asthma; cohort studies; ethnic and racial minorities; management; post-hospitalisation; primary health care.

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Conflict of interest statement

Shamil Haroon reports receiving funding from NIHR and UK Research and Innovation (UKRI). Krishnarajah Nirantharakumar has been awarded research grants from NIHR, UKRI/Medical Research Council (MRC), Kennedy Trust for Rheumatology Research, Health Data Research UK, Wellcome Trust, European Regional Development Fund, Institute for Global Innovation, Boehringer Ingelheim (BI), Action Against Age-related Macular Degeneration charity, Midlands Neuroscience Teaching and Development Funds, South Asian Health Foundation, Vifor Pharma, College of Policing, and CSL Behring, with all payments made to his academic institution; Krishnarajah Nirantharakumar received consulting fees from BI, Sanofi, MSD, and holds a leadership/fiduciary role with Network for Improving Critical care Systems and Training, a charity, and Open Clinical, a social enterprise. Adel H Mansur received personal and institutional funds from AstraZeneca (AZ), GlaxoSmithKline (GSK), Novartis, Sanofi, BI, and Chiesi for talks, advisory board meetings, research, and educational grants. Nicola J Adderley reports receiving funding from NIHR outside the submitted work. Prasad Nagakumar reports receiving grants from NIHR and fees for educational talks and consultancy from Novartis, GSK, and AZ. All other authors have declared no competing interests.

Figures

Figure 1.
Figure 1.
Percentage of patients receiving any asthma management in primary care after a asthma-related hospital admission from the time of hospital discharge in a) children, b) adolescents and c) adults.
See this image and copyright information in PMC

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