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Management and Asthma: Audit facilitators in childhood asthma

Bandolier actively looks for examples of effectiveness in management. An excellent example of a controlled trial of an audit facilitator in the diagnosis and treatment of childhood asthma in general practice is well worth a read [1]. It was set up to test the hypothesis that an audit facilitator could change the pattern of diagnosis and treatment of childhood asthma.

Setting and design

The setting was 12 general practices in Tayside, with 73,000 patients, 12,500 of whom were aged 1 - 15 years. Children in the practices were stratified by age and then randomised into intervention and control groups within each practice. Children chosen were those with histories suggestive of asthma - about 1,500 each in the intervention and control groups.

The intervention comprised provision of information and equipment required for each practice to offer all the children in the intervention group a systematic or opportunistic review, follow up, assessment, educational material and emergency treatment.

Those in the intervention group had a project sticker on the front of their case records. Attached to the records were a chart for asthma diagnosis, a protocol for managing asthma attacks, a letter suggesting that the GP review the patient and guidelines on treatment.


For review, year 1 was the 12 months before the facilitator's visit to the practice, and year 2 the 12 months following the visit. Recorded were:
  • practice initiated consultations
  • patient initiated consultations
  • structured asthma assessments
  • diagnosis of asthma
  • prescriptions of respiratory drugs
  • type and cost of prescriptions
  • admissions and attendances at outpatients and A&E.


This paper contains excellent analysis and results. Compared with controls the intervention group had more practice initiated consultations for asthma, more new diagnoses of asthma, and were more frequently prescribed inhaled cromoglycate.

In the intervention group hospital inpatient days fell from 155 to 122, but rose from 69 to 117 in the control group between the year before and the year after study.

Total primary care and secondary care costs rose by 4.4% in the intervention group, but rose by 13.9% in the control group.

This was without the salary costs of the facilitator, and conclusions about the long-term overall economic impact of this type of intervention need more analysis than the paper was able to give - mainly because these were snapshot estimates which could well change with longer term improved awareness.


1: FP Bryce, RG Neville, IK Crombie, RA Clark, P McKenzie. Controlled trial of an audit facilitator in diagnosis and treatment of childhood asthma in general practice. British Medical Journal 1995 310: 838-42.

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