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The facilitator effect: results from a four-year follow-up of children with asthma
C McCowan1, R G Neville, I K Crombie
1Tayside Centre for General Practice, University of Dundee.
Insights
Audit facilitators improved childhood asthma care temporarily, with no lasting effects after the intervention ended. While cost-effective during the intervention, long-term outcomes remained similar between groups.
Area of Science:
- Pediatric respiratory health
- Health services research
- Quality improvement in healthcare
Background:
- Childhood asthma management requires long-term evaluation of primary and secondary care processes.
- The effectiveness of audit facilitators in improving childhood asthma care needs further investigation.
Purpose of the Study:
- To assess the long-term impact of an audit facilitator intervention on childhood asthma management.
- To analyze the associated health service costs of this intervention.
Main Methods:
- A 4-year follow-up study involving 2557 children (aged 1-15) across 12 general practices.
- Data collected included primary care consultations, prescriptions, hospital contacts, and costs before and after facilitator intervention.
- Facilitators encouraged asthma diagnosis and treatment in the intervention group.
Main Results:
- Improvements in consultation patterns, prescriptions, and reduced hospital admissions were observed during the intervention year but did not persist.
- Two and three years post-intervention, care processes and outcomes were comparable between intervention and control groups.
- Health service cost reductions in the intervention group offset the cost of the facilitator.
Conclusions:
- The positive effects of audit facilitators on childhood asthma care are limited to the intervention period.
- While potentially cost-effective during implementation, the long-term impact on patient outcomes requires consideration.
Background:
A long-term evaluation of the process and outcomes of primary and secondary care is required to establish whether audit facilitators can improve the care of childhood asthma.
Aim:
To examine the long-term effect of an intervention by an audit facilitator on the management of children with asthma, and to investigate the implications for health service costs.
Method:
A 4-year follow up was conducted of an intervention and control group totalling 2557 children aged 1-15 years from 12 general practices in the Tayside region. Primary care consultations, prescriptions, hospital contacts and health service costs 1 year before and 3 years after a facilitator visited practices were recorded. The facilitator encouraged the diagnosis and treatment of childhood asthma in the intervention group.
Results:
Favourable changes in consultation patterns, prescriptions and reduced hospital admissions seen during the intervention year did not persist in subsequent years. Two and three years after the facilitator visit the process and outcome of care was similar in both groups. The reduction in health service costs seen in the intervention group was equivalent to the cost of employing a facilitator.
Conclusion:
The effect of a facilitator lasts only for the period of intervention. Enthusiasts will say that improving patient care without increasing health service costs justifies the widespread deployment of facilitators. Others more interested in long-term outcomes may disagree.