Involving patients in checking the validity of the NHS shared record: a single practice pilot.

OBJECTIVE: To assess how involved patients wish to be in the compilation of their NHS core clinical record, and to assess the accuracy of general practitioner (GP) produced summaries. DESIGN, SETTING, METHOD AND PARTICIPANTS: In a Scottish urban practice of 6800 patients we compiled a core clinical summary based on historical paper and electronic records. We invited a 1 in 10 sample of our patients of all ages to request, view and check a copy of their core clinical record. We offered patients the chance to discuss and correct any inaccuracies in their core clinical summary by use of a response form, telephone or meeting. RESULTS: Out of 646 patients, 258 (40% of our sample) responded to the invitation to check their core clinical summary. Of those, 187 (72.5%) of these summaries were accurate according to patients. There were 89 inaccuracies reported by patients. Of these, 42 (47%) were of obvious clinical importance including wrongly entered diagnoses, or missing major morbidity such as an operation, or errors in repeat medication. There were 47 (53%) inaccuracies in lifestyle data (smoking, alcohol history or weight), or dates of illnesses. CONCLUSION: Only a minority of patients chose to view and offer comment on their core clinical summaries. The majority of summaries were deemed to be accurate but there was a worrying level of omission and inaccuracy, including medication. It might be a better use of time to support doctors and patients working together to construct and check summaries rather than on information technology (IT) and the complex ethical debate surrounding the core clinical Spine.

Do the British Guidelines for Asthma Management facilitate concordance?

BACKGROUND: Asthma is an example of a common, chronic illness in which clinicians are encouraged to promote concordance and adhere to guidelines. Some existing research suggests that these aims may be incompatible. OBJECTIVES: To describe patient goals for life and for asthma management in order to inform concordance with people with asthma. DESIGN: A cross-sectional, qualitative survey. SETTING AND PARTICIPANTS: A purposive sample of 47 adults with asthma from Dundee, UK. The subjects were identified from general practice asthma registers and had a range of ages and asthma severity but no significant comorbidity. METHODS: Tape-recorded semi-structured interviews. The topic guide was based on the literature and had been piloted in a previous study. RESULTS: The participants focussed on improving their lives, only aiming to improve their asthma as a means of improving their lives. Three aspects of asthma were reported to help or hinder improving life: the use of asthma medication, trigger avoidance and exercise. People integrated these three aspects of asthma in order to maximize life. CONCLUSIONS: The study supports the more individualized goals of the recently revised British Guidelines for Asthma Management but highlights the need to develop this further in future revisions. It also provides an explanation for patients' acceptance of less than 'perfect' asthma control and it suggests that shared goals may be achieved in practice by considering the advantages and disadvantages of medication and allergen avoidance on everyday life rather than on asthma.

Asthma or COPD? An inwestigation into the symptom patterns of asthma may highlight the need for more rigorous diagnostic procedures in elderly patients.

AIM: To investigate the symptom patterns of elderly patients registered as active asthmatics. METHOD: An observational study using a database of 393 practices from throughout the United Kingdom. Participating practices provided health-service resource-use and symptom data for 30 randomly selected asthma patients. 8,244 adults, (16+ years), were stratified into three age groups, 4315(52%) aged 16-44, 2339(28%) 45-64, and 1590(19%) 65+. Comparisons were made for management and outcome measures (attack incidence, symptoms, health service resource use, drug therapies) between the groups. RESULTS: Patients over 64 years old experienced more morning and exercise symptoms(p<0.001) and had more hospital admissions(p<0.001). They received higher levels of medication(p<0.001), were more compliant(p<0.001), but had poorer inhaler technique(p<0.001). CONCLUSION: Despite higher medication levels, 1,164(73%) patients over 64 years reported symptoms, 430(37%) of these, daily. For older patients, where regular symptoms are present despite high medication levels, investigation for diagnoses other than asthma should be routine.

Guidelines into practice: An international pilot study of "Asthma Crystal Byte".

INTRODUCTION: Decision support software offers an opportunity to improve the care of patients with asthma by linking individual management decisions to guidelines. METHOD: A guidelines based software package linked to a large database and incorporating a morbidity predictive function was developed in the United Kingdom. Clinicians from several European countries volunteered to evaluate the package in their own clinical environment. RESULTS: The package was run during consultations with patients in the UK, Portugal, Switzerland and Italy. Clinicians agreed on a need for local translations, local drug choices and guidelines to be developed. An emphasis on allergy, immunology and smoking cessation advice in asthma care in some countries highlighted a need to adapt country specific versions. CONCLUSIONS: This International pilot study demonstrated that clinicians can learn from each other and work together around a common theme of implementing guidelines using decision support software.