Aims: To evaluate the effect of the implementation of an asthma clinical path way on asthma in children in general practice. Methods: A randomized, controlled trial involving 270 general practitioners. One group of ge...Aims: To evaluate the effect of the implementation of an asthma clinical path way on asthma in children in general practice. Methods: A randomized, controlled trial involving 270 general practitioners. One group of general practitioners i mplemented the asthma clinical pathway for children (intervention group)- and t he control group continued with their usual asthma medical care management. The main outcome measures were admissions to hospital for asthma and attendance at t he Children’s Emergency Department. Compliance with the guidelines was assesse d by examining asthma drug prescriptions. Results: Admissions to hospital for as thma dropped 40% in the intervention group, by 33% in the control group and by 22% in general practitioners not participating in the trial. The difference s between the intervention and control and between the intervention and non- pa rticipating general practitioners were not statistically significant. The decrea se in attendance at the Children’s Emergency Department decreased by 25% , 30 % and 19% , respectively, but this was not statistically signifi- cant. Ther e was a significant decrease in prescriptions for oral relievers, dry powder rel ievers in the under 6s, mast cell stabilizers and methylxanthines in both contro l and intervention groups. However, only for oral relievers was there a signific ant difference between the intervention group and control, with the decrease lar ger in the intervention group (p < 0.001). Conclusions: Admissions to hospital f or asthma decreased, as did attendance at the Children’s Emergency Department. Prescriptions for asthma medication changed in the direction anticipated with c ompliance with the asthma clinical pathway. However, we found no evidence within the study that implementation of the asthma clinical pathway by general practit ioners resulted in lower morbidity than those general practitioners who did not implement the pathway. Possible explanations are that these general practitioner s were already providing care according to the recommendations of the pathway, o r that there was contamination of the control group by the intervention, or that the guidelines, although based on currently accepted recommendations, are ineff ective.展开更多
文摘Aims: To evaluate the effect of the implementation of an asthma clinical path way on asthma in children in general practice. Methods: A randomized, controlled trial involving 270 general practitioners. One group of general practitioners i mplemented the asthma clinical pathway for children (intervention group)- and t he control group continued with their usual asthma medical care management. The main outcome measures were admissions to hospital for asthma and attendance at t he Children’s Emergency Department. Compliance with the guidelines was assesse d by examining asthma drug prescriptions. Results: Admissions to hospital for as thma dropped 40% in the intervention group, by 33% in the control group and by 22% in general practitioners not participating in the trial. The difference s between the intervention and control and between the intervention and non- pa rticipating general practitioners were not statistically significant. The decrea se in attendance at the Children’s Emergency Department decreased by 25% , 30 % and 19% , respectively, but this was not statistically signifi- cant. Ther e was a significant decrease in prescriptions for oral relievers, dry powder rel ievers in the under 6s, mast cell stabilizers and methylxanthines in both contro l and intervention groups. However, only for oral relievers was there a signific ant difference between the intervention group and control, with the decrease lar ger in the intervention group (p < 0.001). Conclusions: Admissions to hospital f or asthma decreased, as did attendance at the Children’s Emergency Department. Prescriptions for asthma medication changed in the direction anticipated with c ompliance with the asthma clinical pathway. However, we found no evidence within the study that implementation of the asthma clinical pathway by general practit ioners resulted in lower morbidity than those general practitioners who did not implement the pathway. Possible explanations are that these general practitioner s were already providing care according to the recommendations of the pathway, o r that there was contamination of the control group by the intervention, or that the guidelines, although based on currently accepted recommendations, are ineff ective.
