Endocrinología : las glándulas y sus funciones

Data tomado do colofó

An academic, pharmaceutical and practice collaboration to implement asthma guidelines

AIMS: To investigate whether a patient review service changes the management of asthma in accordance with BTS/SIGN Guidelines. METHODS: An observational study of routine review consultations for patients with asthma registered at 862 practices throughout the United Kingdom. Practices recorded reviews on a computer template and returned the information to an academic unit for analysis. RESULTS: 41,493 patients had data returned with 14,790 (36%) patients reporting symptoms at rest or on a daily basis and 15,840 (38%) patients overusing their short-acting ?2-agonist. 4,556 (74%) of patients with symptoms who had a subsequent consultation reported a reduction in their symptoms, whilst 3,932 (63%) reported a reduction in short-acting ?2-agonist use. Night-time, daytime, and activity symptom scores, and short-acting ?2-agonist use, were significantly reduced for patients reviewed more than once. CONCLUSION: There are a large proportion of patients suffering symptoms at rest or on a daily basis. There was a significant reduction in symptom levels and use of reliever medication for patients who were reviewed. A review service implementing the BTS/SIGN guidelines for asthma management would seem to improve patient outcomes

Pragmatic 'real world' study of the effect of audit of asthma on clinical outcome

AIMS: To test whether participation in clinical audit is associated with improved care of a long-term health condition. METHODS: Real world study comparing 1339 patients of all ages and severity of asthma managed by 77 self-selected highly motivated general practices in Scotland with 9617 patients from 319 practices from a national sample. RESULTS: Patients managed by audit practices had more structured clinical reviews by nurses [817 (61%) versus 4301 (45%) OR 0.52, 95% CI 0.46?0.58] and less acute GP contacts [440 (33%) v 4161 (43%) OR 1.56, CI 1.38?1.56]. Consequently they experienced more checking of inhaler technique, use of peak flow meters and self- management plans. Audit patients had more symptom free days [365 (42%) v 2216 (23%) OR 0.80, CI 0.70.0.91], and fewer asthma attacks [217 (16%) v 1938 (20%) OR 1.30, CI 1.12.1.53]. They made less use of hospital services including A&E [30 (2%) v 326 (3%) OR 1.53, CI 1.03,2.28] and outpatients [42 (3%) v 459 (5%) OR 1.55, CI 1.11.2.16]. CONCLUSIONS: Patients with asthma benefit from being managed by a practice involved in a programme of audit

Cross-sectional observations on the natural history of asthma

BACKGROUND: Asthma is a major health care problem that affects all ages. It is uncertain whether asthma is a single clinical entity or a grouping of separate clinical syndromes that share a common set of treatment guidelines. AIM: To observe the symptoms, treatment step, and health service utilisation of a population of patients throughout the United Kingdom (UK) listed on an asthma register. DESIGN OF STUDY: A cross-sectional study and clinical assessment of asthma patients. SETTING: A total of 12,203 patients from 393 general practices throughout the UK. METHOD: A database was used to observe the symptoms, treatment step, and health service utilisation of the asthma patients. RESULTS: Children aged up to four years had a distinctive profile of symptoms, including night time cough. They also experienced increased health service utilisation including a high hospital admission rate. Symptoms in adults became more common with increasing age. The pattern of symptoms in patients aged 45 years and over suggest many patients on asthma registers may have chronic obstructive pulmonary disease. Patients aged 16 to 30 years showed a different pattern of health service usage to those aged 5 to 15 years and 31 to 45 years, relying more on unscheduled use of health services rather than a review-based management plan. Patients aged 16 to 30 years used less anti-asthma medication than those aged 5 to 15 years and 31 to 45 years. CONCLUSIONS: Databases may be a useful tool with which to study the natural history of asthma, but there are problems with bias. Several clinical subgroups exist within the broad diagnosis label of asthma. Knowledge of how these subgroups of doctor-diagnosed asthma use health services may help clinicians to create individual care plans for groups of patients

Scottish asthma management initiative

OBJECTIVES: To describe the development process of a system that links audit, research and patient care and to detail the lessons learned from establishing a Scotland wide asthma management initiative. DESIGN, SETTING AND SUBJECTS: Health Boards and practices throughout Scotland were invited to participate in an initiative which links review of care, guideline implementation, chronic disease management (CDM) approval and post-graduate education for doctors (PGEA) and nurses (PREP). Participating practices were given the materials to review 30 patients randomly selected from their asthma register. Health service resource use and drugs prescribed over a retrospective 12 month period were recorded for each patient using paper or electronic materials. All patients were invited for clinical assessment. RESULTS: A two-tier management system proved effective. Twelve of the 15 Scottish health authorities agreed to recognise the audit for automatic CDM approval although the negotiation process was prolonged; 566 practices from all parts of Scotland have expressed an interest in the initiative. Provision of distance learning material linked to PGEA accreditation is free to general practitioners (GP's) and is a useful incentive for participation. To date 42 GPs have completed the distance learning element. CONCLUSION: The Scottish Asthma Management Initiative has provided the opportunity for all sectors of the health service in Scotland to work together to explore innovative ways to improve the management and care of chronic disease. Participation in an initiative linked to guidelines, education and CDM approval is an excellent way to facilitate health professionals to improve care