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[Asthma management at the interface of general practice and hospital care]
E Hummers-Pradier1, A Frösch, M M Kochen
1Abteilung Allgemeinmedizin, Universität Göttingen. ehummer@gwdg.de
Insights
Asthma management in hospitals often falls short of guidelines, with inadequate anti-inflammatory treatment and poor communication between hospital doctors and general practitioners (GPs). Improvements are needed in implementing asthma care recommendations.
Area of Science:
- Pulmonology
- Internal Medicine
- Healthcare Management
Background:
- Asthma management requires adherence to established guidelines for optimal patient outcomes.
- Effective communication between hospital physicians and general practitioners (GPs) is crucial for continuous patient care.
- Previous assessments indicated potential gaps in asthma care delivery and inter-professional communication.
Purpose of the Study:
- To evaluate the management of hospitalized asthma patients against German Airway League recommendations.
- To assess the communication effectiveness between hospital doctors and general practitioners (GPs) regarding asthma patient care.
- To identify areas for improvement in asthma treatment protocols and discharge planning.
Main Methods:
- Retrospective review of 169 patient records (asthma/COPD, ICD9) discharged between January 1996 and June 1998.
- Selection of 93 patients with pre-existing asthma as the reason for hospitalization.
- Analysis of pre-hospitalization GP treatment, in-hospital diagnostics/treatment, discharge recommendations, and GP responses to case vignettes.
Main Results:
- Most patients received theophyllin (66%) and inhaled beta-mimetics (62%) pre-hospitalization; steroid use was low (topical 44%, oral 29%).
- In-hospital, lung function tests (8%) and peak flow monitoring were infrequent.
- 47% were discharged without adequate anti-inflammatory treatment, and discharge letters lacked specific management recommendations.
Conclusions:
- Hospital asthma management often deviates from German Airway League guidelines, with overreliance on theophyllin and antibiotics, and insufficient anti-inflammatory therapy.
- Diagnostic procedures like lung function testing and peak flow monitoring were underutilized in hospitals.
- Communication gaps exist between hospital doctors and GPs, necessitating improved collaborative care strategies for asthma patients.
Abstract:
The aim of the study was to assess the management of patients hospitalised for asthma with regard to the recommendations of the German Airway League, and the communication between hospital doctors and general practitioners (GPs). All records of patients discharged with asthma or COPD (ICD9) between 1/1996 and 6/1998 were retrieved (n = 169) in one general hospital. All patients whose asthma had been known in admission and was given as a reason for hospitalisation in the discharge letter were selected (n = 93). Treatment prescribed by the patients' GPs before hospitalisation as well as diagnostic procedures and treatment in hospital and the recommendations in the discharge letter were reviewed. Additionally the GPs were questioned with case vignettes. Before hospitalisation, most patients had been treated with theophyllin (66 %) and inhaled betamimetics (62 %), only 44 % had received topical and 29 % oral steroids by their GP. In hospital, lung function assessment was performed in only 8 % of the patients and there was no monitoring of the peak flow. The most commonly prescribed drugs were theophyllin (94 %), mucolytics (94 %) and antibiotics (82 %). Half of the patients (47 %) were discharged without adequate anti-inflammatory baseline treatment. The discharge letters did not contain detailed recommendations on future asthma management. There seems to be room for improvement with regard to the implementation of the German Airway League's recommendations both in hospital and in general practice: Few patients received systemic or inhaled steroids, whereas theophyllin and antibiotics were prescribed routinely. In hospital, airway obstruction was neither measured initially nor monitored. Communication between hospital doctors and GPs seems to be insufficient.
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