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Asthma guidelines highlight the importance of regular review because non-attendees have increased morbidity. This study is the first to look at telephone consultation as a means of improving review rates. Eligible patients were adult (>18 years) asthmatics (>1 year) who had requested an inhaled bronchodilator within the past 6 months but had not been reviewed in 11 months or more. 932 eligible patients were identified in four practices; 278 (29.8%) consented to participate and were randomised to telephone or standard face to face review, both by a trained asthma nurse. The primary outcome measures were the proportion of patients reviewed and change in asthma quality of life at 3 months. Secondary outcome measures were asthma morbidity, patient satisfaction, and consultation duration. On an “intention to review” analysis, 74% of patients in the telephone arm were assessed compared with 48% in the standard review arm (p<0.001). There was no difference in the quality of life at 3 months. The study was underpowered to assess the secondary outcomes rigorously, but morbidity and satisfaction were similar and the telephone consultations shorter.
The authors conclude that telephone consultations improve access, are shorter and therefore more efficient, and do not result in clinical disadvantage or loss of satisfaction. They do not, however, report how important areas such as inhaler technique might be assessed, and the follow up period was short. This intriguing study hints at future developments in the delivery of asthma care.
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