CONTROLLED TRIAL OF AN AUDIT FACILITATOR IN DIAGNOSIS AND TREATMENT OF CHILDHOOD ASTHMA IN GENERAL-PRACTICE

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 pound 30 118 to pound 37 243 in the intervention group and fell from pound 29 131 to pound 27 990 in the control group. Hospital care cost fell in the intervention group from pound 25 406 to pound 20 727 and rose in the control group from pound 12 699 to pound 19 650. Conclusion-An audit facilitator can favourably influence the pattern of diagnoses and treatment of childhood asthma in general practice. This may have an impact on health service costs.