A controlled retrospective pilot study of an ‘at-risk asthma register’ in primary care

There are few reports of primary care initiatives designed to improve management of asthma patients who are at risk of adverse outcomes. To assess the impact on emergency treatments, service use, and costs, of introducing an at-risk asthma register in a general practice surgery. Asthma patients demonstrating characteristics associated with adverse outcomes were added to an at-risk register. Tags were placed in patients’ records and practice staff were trained to ensure their appropriate recognition and management. Data were retrospectively extracted from the notes of 26 identified at-risk patients, as well as 26 age-, sex-, and treatment-matched controls with asthma, for one year before and after the introduction of the register. Implementation and service use costs were estimated. Before introduction of the register, more ‘at-risk’ than control patients were hospitalised (3 vs. 0), attended the accident and emergency (A&E) department (1 vs. 0), and were nebulised (4 vs. 0), for asthma. Significantly higher numbers also used out-of-hours services, received oral steroids, attended their general practitioner (GP), and failed to attend scheduled clinics for asthma (all p < 0.025). After introduction of the register, no at-risk patients were admitted or attended A&E. Although differences in the numbers receiving oral steroids remained ( p = 0.05), other differences disappeared. There were notably greater reductions in overall numbers of admissions, out-of-hours attendances, GP attendances, courses of steroids, and total costs associated with service use, amongst ‘at-risk’ as compared to control patients. An at-risk asthma register is a low cost initiative warranting further evaluation, since it may facilitate appropriate service use in a vulnerable and costly patient group.