Biomedical subjects
I Charlton
Publications and source records attributed to I Charlton.
Australian divisions of general practice asthma survey 1997. General Practitioner's Asthma Group of the National Asthma Campaign.
AIM: To conduct an attitudinal postal survey of all 118 divisions of general practice known to the National Asthma Campaign. METHOD: A questionnaire aimed to determine the perceived barriers to improved asthma care in the divisions, current asthma projects and the most suitable way that the General Practitioners Asthma Group (GPAG) and the National Asthma Campaign (NAC) could assist divisions of general practice. RESULTS: Eighty seven (74%) replies were received. Twenty-four divisions (28%) were running asthma projects, mostly about asthma education. The greatest barrier to asthma care for the doctor was a lack of time (57% of respondents) and the greatest barrier for the patient was perceived to be a lack of asthma education (34% of respondents). Asthma educators employed by the division or individual surgeries were ranked as the preferred method for overcoming these difficulties. CONCLUSIONS: Divisions of general practice are becoming involved in the management of asthma throughout Australia although there are considerable hurdles to overcome. The role of the GPAG and NAC in this process is discussed.
Caring for patients with asthma. Teaching self management takes time.
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Asthma at the interface: bridging the gap between general practice and a district general hospital.
A clinic supervised by a nurse, using principles originally developed in general practice, was established in the paediatric department of a district general hospital. A randomised controlled study was conducted comparing children admitted with asthma or attending outpatients who were given a patient education programme and self management plan (intervention group) with a control group. The study comprised 91 patients aged 3-14 years admitted for asthma or attending a hospital outpatient department from November 1989 to November 1990. Seventy seven patients completed the study and kept diaries for a median of 283 days. Patients in the intervention group had significantly less restriction of activity (95% confidence interval (CI) -0.27 to -0.01) and fewer episodes of peak flow below 30% of best (95% CI 0.03 to 1.17). Patients in the intervention group were more likely to make the correct response to an acute exacerbation of their asthma than the control group (71% v 47%, 95% CI 9.51 to 39.1). The intervention group had fewer school absences and fewer home visits by a general practitioner. There was an increase in the readmission rate for the intervention group. A subgroup of patients who self managed by doubling their use of inhaled steroids during an exacerbation performed better than those patients who only increased their bronchodilator or were managed on salbutamol or sodium cromoglycate alone. Improvements in patient follow up and the structure of the self management plans used, particularly changing the peak flow level at which inhaled steroids are doubled, may further improve the outcome of patients attending the asthma clinic.
An evaluation of a nurse-run asthma clinic in general practice using an attitudes and morbidity questionnaire.
A before and after longitudinal study was conducted to evaluate a nurse-run asthma clinic in general practice. Sibbalds morbidity and attitudes questionnaire was used to monitor the changes in association with attendance at the clinic. One hundred and five patients aged 3-83 years attended the clinic. Over the 12 months of the study patients reported significant reductions in attacks of wheeze, nocturnal attacks, overall trouble (P eta 0.005) and GP home visits (P = 0.02). Patients also reported a significant improvement in feelings of stigma (P less than 0.001), and confidence in self-care (P less than 0.001). There was a significant association between morbidity criteria such as 'overall interference' and stigma at the outset of the clinic (R = -0.44; P less than 0.001; 95% confidence interval -0.58 to -0.26). A patient's feelings of stigma towards their asthma at the outset did not predict the eventual improvement in morbidity. As the patient's asthma improved the feelings of stigma became less apparent. This would suggest that improving a patient's morbidity should be one of the first priorities in asthma care. Confidence in the doctor was high at the outset and did not change throughout the study, despite the fact that a large proportion of patients wanted more information about their asthma but found it difficult to talk to their doctor. General practitioners are often restrained by how much time and resources they can devote to each patient. The nurse-run asthma clinic with its programme of structured care represents a possible solution to these problems.
Delay in diagnosis of childhood asthma and its influence on respiratory consultation rates.
A survey of cases of asthma in two general practices with a special interest in the disease identified 212 asthmatic children aged 0-16 years by the end of January 1989 who had been registered in that practice since birth. Delay in diagnosis, both in terms of time (median 2.95 years) and number of consultations (median 7), was considerable. Annual rates of consultations for respiratory symptoms that were initiated by the patients fell significantly after diagnosis (median before = 1.80, after = 0.95 consultations/year), but the number initiated by the doctors rose significantly (median before = 0, after = 1.01 consultations/year). The overall rates before and after diagnosis were not significantly different (median before = 2.04, after = 2.21 consultations/year). Increased efforts are required to reduce this delay thereby minimising the morbidity of asthma in childhood.
Audit of the effect of a nurse run asthma clinic on workload and patient morbidity in a general practice.
The aim of this study was to assess the effect of a nurse run asthma clinic on practice workload and the morbidity of patients in a four partner general practice. One hundred and fifteen asthmatic patients were studied and comparisons were made between the 12 months prior to the introduction of the clinic and the first 12 months after the clinic started. Morbidity was measured in terms of: the number of courses of oral steroids, the number of emergency salbutamol nebulizations, and the number of days lost from work or school. The number of consultations with the general practitioners were recorded. The repeat prescribing register was also monitored throughout the study to examine the effect of the clinic on prescribing in the practice. Consultations with general practitioners fell from a total of 818 to 414 during the study period (P less than 0.001). This was offset by 496 consultations with the nurse in the first 12 months of the clinic. As a result of attending the nurse clinic significant reductions (P less than 0.01) were found in the patients' requirements for courses of oral steroids, acute nebulizations and days lost from work or school. The results for the 46 children were similar to those for the 69 adults, confirming that the asthma clinic was effective for all ages. The clinic coincided with an increase in the number of patients receiving regular bronchodilator therapy and prophylactic medication. Eighty per cent of patients had their medication modified as a result of attending the clinic. The cost of prescribing remained remarkably stable.(ABSTRACT TRUNCATED AT 250 WORDS)
The care of children with asthma in general practice: signs of progress.
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Evaluation of peak flow and symptoms only self management plans for control of asthma in general practice.
OBJECTIVE: To compare a peak flow self management plan for asthma with a symptoms only plan. DESIGN: Randomisation to one of the self management plans and follow up for a year. SETTING: Four partner, rural training practice in Norfolk. SUBJECTS: 115 Patients (46 children and 69 adults) with asthma who were having prophylactic treatment for asthma and attending a nurse run asthma clinic. MAIN OUTCOME MEASURES: The number of doctor consultations, courses of oral steroids, and short term nebulised salbutamol treatments and the number of patients who required doctor consultations, courses of oral steroids, and short term nebulised salbutamol. RESULTS: Both self management plans produced significant reductions in the outcome measures but there were no significant differences in the degree of improvement between the groups. The results were similar for children and adults. The proportions of patients requiring a doctor consultation fell from 98% (50/51) to 66% (34/51) in the peak flow group and from 97% (62/64) to 53% (34/64) in the symptoms only group and the proportions requiring oral steroids from 73% (34/46) to 47% (21/46) and 52% (31/60) to 12% (7/60). The median number of doctor consultations was reduced from 8.0 to 2.0 in the peak flow group and from 4.5 to 1.0 in the symptoms only group. CONCLUSIONS: The peak flow meter was not the crucial ingredient in the improved illness of the two groups. Teaching patients the importance of their symptoms and the appropriate action to take when their asthma deteriorates is the key to effective management of asthma. Simply prescribing peak flow meters without a system of self management and regular review will be unlikely to improve patient care.
New perspectives in asthma self-management.
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Cardiac conducting tissue. A simplified technique for examination of the SA and AV nodes.
We describe a modified method for examination of the atrioventricular and sinoatrial nodes that displays the major elements of the cardiac conducting system, yet is not time-consuming for the technician. We examined 31 cases in three categories: cases with previous cardiac history, sudden deaths from no known cause, and cases where death was sudden and accidental. All cases showed histologic abnormalities in the cardiac tissue. We contend that our method would permit such examination to be routinely used in the pathology laboratory.
Asthma clinics: audit.
Our three articles on general practice asthma clinics conclude by considering the ways in which the effectiveness of the clinic can be measured.
Asthma clinics: how to run one.
In this second article describing the establishment of a general practice asthma clinic, a protocol for clinic procedure is suggested.
Asthma clinics: setting up.
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Blood pressure variability: the effects of repeated measurement.
A series off 3 BP measurements were carried out on 2 groups of people. People not accustomed to BP measurements showed a decrease in pressure between the 1st and 3rd cuff inflation, while people trained to having their BP measured showed no such change. Measurement of the BP of 111 people on 2 successive occasions 8 days apart showed that the mean BP of the whole group decreased between visits. Approximately one third of the people showed a drop in pressure bringing them from borderline hypertension to normotension between the 2 visits. People whose BP dropped substantially between the 1st and 2nd visits achieved higher anxiety scores on a questionnaire than did the remainder of the sample. This may partially explain their labile BP. Single measurements tend to overestimate the BP and the frequency of hypertension. Training experimental subjects by repeated measurement of their BP may be useful in preventing spurious BP changes unrelated to experimental manoeuvres.
Usefulness of a patient library in a suburban general practice.
OBJECTIVES: To provide health information by means of a patient library in an Australian general practice, and to examine the effects of such information on patient knowledge, anxiety and behaviour. DESIGN: Questionnaire survey of patients who borrowed library items and of doctors within the practice. SETTING: A five-doctor suburban practice serving approximately 7000 patients. RESULTS: 210 items were purchased and made available for loan over the two years of the study; 164 questionnaires were obtained after 229 borrowings in the first 15 months. Patients who borrowed items were mostly women (88%) and a high proportion of borrowers (47%) felt that the doctors' surgery was their main source of health information. 98% felt that borrowing an item had been "useful" or "very useful", 88% felt that it had increased their knowledge, 48% felt it had decreased their anxiety, and 79% felt it had changed their behaviour. The doctors were generally positive about the library. CONCLUSIONS: The practice library was a very useful addition to the surgery services and provided a valuable clinical tool for the doctors.
Self-management plans for asthma control.
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