Improved management of asthma

Abstract

A Tattersfield and T Harrison make useful suggestions in their Aug 25 commentary1Tattersfield AE Harrison TW Exacerbations of asthma—still room for improvement.Lancet. 2001; 358: 599-600Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar for improved management of asthma exacerbations, but oversimplify factors relating to primary care.Patients in the UK may have difficulties gaining access to their family physicians, but routine and urgent access has been rated worse by black and Asian groups.2Campbell JL Ramsay J Green J Age, gender, socioeconomic, and ethnic differences in patients' assessments of primary health care.Int J Qual Health Care. 2001; 10: 90-95Crossref Scopus (200) Google Scholar In the USA, hospital admission rates in urban areas for asthma and other disorders are inversely related to patient-rated access to care;3Bindman AB Grumbach K Osmond D et al.Preventable hospitalizations and access to health care.JAMA. 1995; 274: 305-311Crossref PubMed Scopus (742) Google Scholar 75% of children from deprived areas (94% Hispanic or black) used accident and emergency departments for short-term care, and more than half reported difficulty accessing care and getting follow-up care.4Crain EF Kercsmar C Weiss KB Mitchell H Lynn H Reported difficulties in access to quality care for children with asthma in the inner city.Arch Pediatr Adolesc Med. 1998; 152: 333-339Crossref PubMed Scopus (131) Google ScholarIn a qualitative study in east London, UK, of south Asian and white adults admitted with asthma,5Griffiths C Kaur G Gantley M et al.Influences on hospital admission for asthma in white and south Asian adults: a qualitative interview study.BMJ. 2001; 323: 962-966Crossref PubMed Scopus (69) Google Scholar we noted that the south Asian group had poor understanding and use of inhaled and systemic corticosteroids and greater difficulty accessing emergency care from their family physician. South Asian patients tended to be registered with practices that lacked advanced strategies for asthma care, especially for access in an emergency.These differences go some way to explaining differences in hospital admission rates for asthma between white and south Asian groups in the UK. Improvement of access to high-quality primary care is a key part of reducing health inequalities and the burden of asthma in secondary care. A Tattersfield and T Harrison make useful suggestions in their Aug 25 commentary1Tattersfield AE Harrison TW Exacerbations of asthma—still room for improvement.Lancet. 2001; 358: 599-600Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar for improved management of asthma exacerbations, but oversimplify factors relating to primary care. Patients in the UK may have difficulties gaining access to their family physicians, but routine and urgent access has been rated worse by black and Asian groups.2Campbell JL Ramsay J Green J Age, gender, socioeconomic, and ethnic differences in patients' assessments of primary health care.Int J Qual Health Care. 2001; 10: 90-95Crossref Scopus (200) Google Scholar In the USA, hospital admission rates in urban areas for asthma and other disorders are inversely related to patient-rated access to care;3Bindman AB Grumbach K Osmond D et al.Preventable hospitalizations and access to health care.JAMA. 1995; 274: 305-311Crossref PubMed Scopus (742) Google Scholar 75% of children from deprived areas (94% Hispanic or black) used accident and emergency departments for short-term care, and more than half reported difficulty accessing care and getting follow-up care.4Crain EF Kercsmar C Weiss KB Mitchell H Lynn H Reported difficulties in access to quality care for children with asthma in the inner city.Arch Pediatr Adolesc Med. 1998; 152: 333-339Crossref PubMed Scopus (131) Google Scholar In a qualitative study in east London, UK, of south Asian and white adults admitted with asthma,5Griffiths C Kaur G Gantley M et al.Influences on hospital admission for asthma in white and south Asian adults: a qualitative interview study.BMJ. 2001; 323: 962-966Crossref PubMed Scopus (69) Google Scholar we noted that the south Asian group had poor understanding and use of inhaled and systemic corticosteroids and greater difficulty accessing emergency care from their family physician. South Asian patients tended to be registered with practices that lacked advanced strategies for asthma care, especially for access in an emergency. These differences go some way to explaining differences in hospital admission rates for asthma between white and south Asian groups in the UK. Improvement of access to high-quality primary care is a key part of reducing health inequalities and the burden of asthma in secondary care.