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Organisation of asthma care in primary health care in Mid-Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. (Family Medicine and Clinical Epidemiology)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD). (Family Medicine and Clinical Epidemiology)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. (Family Medicine and Clinical Epidemiology)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. (Family Medicine and Clinical Epidemiology)
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2005 (English)In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 14, no 3, 147-153 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate the organisation of asthma care in 240 primary health care centres (PHCCs) in Mid-Sweden. METHODS: A cross-sectional study. Main outcomes were occurrence and structure of nurse-based asthma clinics according to nationally recommended criteria, and access and use of spirometers. RESULTS: 238 PHCCs (99%) responded. 16% reported a complete, and 37% an incomplete, asthma clinic. 47% of PHCCs had no asthma clinic. The incomplete asthma clinics usually lacked sufficient asthma nurse time, a scheduled nurse surgery and a responsible GP. 77% of the PHCCs had access to a spirometer and on average 19 spirometries/1000 inhabitants/year were performed. There was a large variation in the use of spirometers. CONCLUSION: Half of the PHCCs had an asthma clinic and a majority had access to a spirometer. More frequent use of spirometry and increased time provision for the asthma nurse would be likely to produce a substantial improvement in the standard of asthma care in primary health care.

Place, publisher, year, edition, pages
2005. Vol. 14, no 3, 147-153 p.
Keyword [en]
Asthma, Primary health care, Quality of health care, Asthma clinic, Spirometer
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-97620DOI: 10.1016/j.pcrj.2005.03.003PubMedID: 16701714OAI: oai:DiVA.org:uu-97620DiVA: diva2:172637
Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Organisation of Asthma in Primary Care, Quality of Life and Sex-related Aspects in Asthma Outcomes
Open this publication in new window or tab >>Organisation of Asthma in Primary Care, Quality of Life and Sex-related Aspects in Asthma Outcomes
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives: To investigate the organisation of asthma care in primary care and evaluate outcomes for patients attending primary care centres with and without asthma clinics.

Other objectives were to study the association between quality of life and asthma control in patients in primary care and to analyse sex differences regarding asthma outcomes related to menopausal status.

Material and methods: Cross-sectional surveys and a patient record study.

Results: Of all the primary health care centres, 77% had a spirometer and 53% an asthma clinic. At centres with asthma clinics 77% of the patients reported sufficient knowledge of asthma as compared with 65% at centres without asthma clinics (p<0.001). With more time allocated for the nurse, 44% of patients achieved asthma control as compared with 27% at asthma clinics with less time (p<0.003). Patients using short-acting beta-2 agonists more than twice in the last week had clinically significant lower MiniAQLQ scores (5.17 versus 5.91). This finding also held for night awakenings during the previous week (4.42 versus 5.86), courses of oral corticosteroids (5.26 versus 5.64) and reported emergency consultations during the last six months (4.85 versus 5.71). Premenopausal women had significantly lower total MiniAQLQ scores than men in the same age group (5.44 versus 5.89, p<0.001), while no difference was found between postmenopausal women and men of similar ages. The adjusted odds for premenopausal women for asthma exacerbations was 2.0 (95%CI 1.22-3.43) as compared with men in the same age group. No differences were found when comparing postmenopausal women with men of similar ages.

Conclusions: Half the primary health care centres had an asthma clinic and the majority had access to a spirometer. Patients at primary health care centres with asthma clinics reported better knowledge of their disease, and asthma control is more often achieved if the nurse is allocated more time. Achieving asthma control is associated with better quality of life in patients in primary care. Premenopausal women had lower quality of life and less often asthma control then men of the same ages, while no corresponding difference was found between postmenopausal women and men of similar ages.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 63 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 384
Keyword
Asthma, Primary Health Care, Cross-Sectional Studies, Quality of Health Care, Asthma clinic, Spirometer, Asthma management, Knowledge, Outcome Assessment, Control, Symptoms, Quality of Life, Sex, Menopause, Sex Hormones
National Category
Family Medicine
Identifiers
urn:nbn:se:uu:diva-9315 (URN)978-91-554-7304-4 (ISBN)
Public defence
2008-11-07, Rudbecksalen, Rudbecklaboratoriet, Science Park, Uppsala, 09:15 (English)
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Supervisors
Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2016-12-22Bibliographically approved

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