Systematic care for asthma in Australian general practice: a randomised controlled trial

Abstract

<h4>Objective</h4>To evaluate whether systematic asthma care involving a register-recall system, postcard prompts for review, and education for general practitioners and staff in Australian general practice improves the quality of care and health outcomes for adult patients with moderate to severe asthma.<h4>Design and setting</h4>Cluster randomised controlled trial in 40 general practices in urban and rural South Australia and New South Wales over the 2 years 2004 and 2005; practices were randomly allocated to the intervention or control group.<h4>Participants</h4>565 adult patients of these randomly allocated practices who had doctor-diagnosed moderate to severe asthma and were taking inhaled corticosteroids.<h4>Main outcome measures</h4>Clinical asthma indicators, quality of care, acceptability of the intervention to patients, quality of life, and asthma self-management skills at baseline, 6 months and 12 months.<h4>Results</h4>Although 46% of patients in the intervention group practices responded to the postcard prompts, only 32% actually attended for their asthma review. At 12 months, there was a statistically significant difference in provision of written asthma action plans (rate ratio, 1.9; 95% CI, 1.0-3.5; P = 0.04) for intervention group patients compared with control group patients; there was no significant difference in other indicators.<h4>Conclusion</h4>We found little objective evidence of improvement in patient management and outcomes resulting from a systematic model of asthma care.<h4>Trial registration</h4>Australian New Zealand Clinical Trials Registry ACTRN12605000091606.