Telephone consultations for the routine review of people with asthma in primary care : an evaluation of a complex intervention
Introduction: Set within the Medical Research Council framework for the development and evaluation of complex interventions, this thesis describes the evaluation of telephone consultations for the routine review of people with asthma in primary care. Objectives: 1. To critically review the evidence for regular review of people with asthma. 2. To develop an intervention, underpinned by existing theoretical and empirical evidence on telephone consulting, to improve access to asthma care. 3. To test the hypotheses that telephone consultations improve access and are an acceptable, clinically effective and cost-effective alternative to face-to-face consultations for the provision of routine asthma care. 4. To design a telephone asthma review service for ‘real-world’ implementation. Methods: Literature review and a randomised controlled trial comparing nurse-led telephone with face-to-face asthma reviews in four UK general practices. Results: 1) Despite the evidence for proactive asthma care, attendance at routine clinics remains poor. 2) Convenience for patients and the potential for opportunistic calls, suggest that telephone consultations might increase the proportion of patients reviewed. 3) 101/137 (74%) of people randomised to telephone consultations were reviewed compared with 68/141 (48%) in the surgery group (p<0.001). Asthma-related quality-of-life was comparable in the two groups (risk difference -0.07 (95%Cl -0.40 to 0.27) p=0.69). The shorter duration of telephone consultations resulted in a mean cost saving per consultation achieved of £3.92 (95%Cl £3.01 to £4.84), p<0.001). Patients appreciated the convenience of telephone reviews. 4) Building on these results, a telephone asthma review service is described for testing in an on-going implementation trial.