Abstract
Introduction:
In solving under-diagnosis and non compliance with follow up in primary care in a Dutch region (West- Brabant and Zeeland), an outreach asthma-COPD service was developed.
Methods:
The service consists of lung function assessments at 23 locations. The GP can order a lung function test and annual monitoring of obstructive patients. The GP is advised on treatment, additional diagnostics and referrals of the patient based on extensive anamnesis, measurement of lung function and Body Mass Index (BMI). The asthma/COPD-service operates with 12 biometrists, 2 asthma/COPD-nurses, 1 lung function-technician, 5 consultant pulmonary physicians (from regional hospitals) and a coordinator/GP. To improve performance in primary care and raise adherence of GPs to the service, GPs are visited by an asthma/COPD-nurse, who gives feedback concerning the number of screened patients and discusses the actions the practice has taken on basis of the advice. Support is also offered to perform a practice survey, the service aids in selecting and diagnosing patients based on medication prescription codes (ATC-code).
Results:
332 GPs use the services (>1 lung function). Since 1996 a total of 28,605 lung-function tests for primary care took place. In 2005 there were 6027 lung function tests performed. 3055 patients are monitored annually. Of 299 GPs (an average of 10.2 patients/GP) are participating annually. 52% of the new patients were obstructive, mostly mild (67%) and moderate (20%). In 2004 the Asthma/COPD-nurse visited 194 GPs. During this visit (30–45 minutes) a number of patients (6 to 10 patients) are evaluated in accordance with the recommendations of the pulmonary physician and implementation of the advice by the GP. The Asthma/COPD-nurse motivates the given advice and gives information that could help to provide practical information, like stop smoking. From 7 GPs 736 patients were selected on medical prescription. 501 patients were invited for lung function tests and 299 were diagnosed asthma/COPD and will be monitored annually.
Conclusion:
AC service fulfils presented needs. De-centralised lung function-tests are approachable for the patients. The cooperation between lung function laboratory, consultant pulmonary physician, Asthma/COPD service, is of large value for the region.
Conflict of interest and funding
None.
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Smeele, I., Denis, J. & van Hessen, P. ABS64: Asthma/COPD service improves diagnosis and monitoring in primary care. Prim Care Respir J 15, 203 (2006). https://doi.org/10.1016/j.pcrj.2006.04.158
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DOI: https://doi.org/10.1016/j.pcrj.2006.04.158