Primary care based clinics for asthma

BACKGROUND:

Primary care clinics for asthma have been encouraged and are becoming widespread in some countries, particularly in the UK.

OBJECTIVES:

To determine the effectiveness of organised asthma care via primary care based asthma clinics.

SEARCH STRATEGY:

A search of the Cochrane Airways Group register and Cochrane Controlled Trials Register using the following search strategy: clinic* OR general pract* OR family pract* or primary care. Separate and additional searches were also conducted using MEDLINE, CINAHL and EMBASE databases.

SELECTION CRITERIA:

Trials had to be performed in primary care and be restricted to patients with asthma. Care could be delivered by doctor or nurse. Two reviewers independently ascertained the relevance of trials from titles and abstracts obtained from the searches. Relevant full text articles were retrieved with two reviewers assessing each study for inclusion.

DATA COLLECTION AND ANALYSIS:

Two reviewers independently conducted all data abstraction and analysis and all disagreements were resolved by discussion. For the dichotomous variables, odds ratio (OR) or relative risks (RR) with 95% Confidence Interval (95%CI) were calculated for individual outcomes.

MAIN RESULTS:

Only one trial met the criteria for inclusion in the review. This trial provided 11 outcome measures of which two showed a significant effect of the intervention. More patients in the intervention group had peak flow meters (RR 1.30; 95%CI 1.05,1.61) and fewer patients in the intervention group were likely to wake up at nights due to their asthma (RR 0.30; 95%CI 0.16, 0.81).

AUTHORS' CONCLUSIONS:

There is limited evidence of benefit for primary care based asthma clinics, but firm conclusions cannot be formed until more good quality trials have been carried out.