ABS009: Impact on asthma morbidity and patient enablement of providing a telephone option for primary care asthma reviews: Phase IV controlled implementation study

Abstract

Introduction:Our recent randomised trial showed that telephone consultations can improve access to asthma reviews without clinical disadvantage.(Pinnock et al, BMJ 2003; 326:477–9) However, concerns have been expressed that telephone consultations in a routine setting may clinically disadvantage patients.Aims and objectives:To compare the effect on asthma morbidity, patient enablement and confidence in asthma managementofroutinely providing atelephone review service vs. a face-to-face review service.Subjects and methods:All registered patients with active asthma (n = 1,213) in a large (n = 31,000) UK practice were included. Existing practice groups were randomised to a review service including a telephone option (TC-option) vs. face-to-face consultations only (FtF-only). Morbidity and enablement questionnaires were sent to all adults and teenagers at 12 months.Results:Questionnaire response rate was 52% (536/1,038). The mini Asthma-related Quality-of-Life and Asthma Control Questionnaires scores were equivalent in both groups: [miniAQLQ: TC-option: 5.29 (SD 1.21) vs. FtF-only: 5.31 (SD 1.24) mean difference 0.02 (95% CI −0.21 to 0.24) p = 0.87] [ACQ: TC-option: 1.20 (SD 1.00) vs. FtF-only: 1.33 (SD 1.13), mean difference 0.12 (95% CI −0.06 to 0.31) p = 0.19]. However, the modified Patient Enablement Instrument and Asthma Bother Profile (management) scores were both significantly improved in the TC-option group: [mPEI: TC-option: 7.29 (SD 4.26) vs. FtF-only: 6.43 (SD 4.30) mean difference −0.83 (95% CI −1.56 to −0.10) p= 0.03] [ABP(m): TC-option: 3.99 (SD 0.84) vs. FtF-only: 3.78 (SD 0.89), mean difference −0.21 (95% CI −0.36 to −0.06) p = 0.007].Conclusions:In a routine setting, providing a telephone option for asthma reviews is equally clinically effective as face-to-face reviews. Average enablement and confidence with asthma management was greater in the TC-option group, perhaps reflecting the increased overall review rate. Conflict of interest and funding None declared. Royal College of General Practitioners Scientific Foundation Board.