Controlled trial of an audit facilitator in diagnosis and treatment of childhood asthma in general practice

Abstract

Objective: To test whether an audit facilitator could alter the pattern of diagnosis and treatment of childhood asthma.

Design: Randomised stratified controlled trial.

Setting: 12 general practices in Tayside.

Subjects: 3373 children aged 1-15 inclusive who had symptoms suggestive of asthma or possible asthma drawn from a systematic review of 10,725 general practice case records.

Intervention: Children were targeted for a clinical review by their general practitioner or practice nurses.

Main outcome measures: Asthma related consultations, prescriptions, hospital attendances, and health service costs 12 months before and after study.

Results: Compared with controls (n = 1563) the intervention group (n = 1585) had more practice initiated consultations for asthma (relative risk 2.18 (95% confidence interval 1.74 to 2.73)), new diagnoses of asthma (2.83 (2.26 to 3.54)), and past diagnoses reaffirmed (1.30 (1.08 to 1.58)), and they were more frequently prescribed inhaled cromoglycate (1.52 (1.02 to 2.25)). Hospital inpatient day rates fell from 152 to 122 in the intervention group and rose from 69 to 117 in the control group between the year before and the year after study. Total primary care costs rose from 30,118 pounds to 37,243 pounds in the intervention group and fell from 29,131 pounds to 27,990 pounds in the control group. Hospital care cost fell in the intervention group from 25,406 pounds to 20,727 pounds and rose in the control group from 12,699 pounds to 19,650 pounds.

Conclusion: An audit facilitator can favourably influence the pattern of diagnosis and treatment of childhood asthma in general practice. This may have an impact on health service costs.