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https://hdl.handle.net/2440/53637
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Type: | Journal article |
Title: | Models of chronic disease management in primary care for patients with mild-to-moderate asthma or COPD: a narrative review |
Author: | Cranston, J. Crockett, A. Moss, J. Pegram, R. Stocks, N. |
Citation: | Medical Journal of Australia, 2008; 188(8 Suppl):S50-S52 |
Publisher: | Australasian Med Publ Co Ltd |
Issue Date: | 2008 |
ISSN: | 0025-729X 1326-5377 |
Statement of Responsibility: | Josephine M. Cranston, Alan J. Crockett, John R. Moss, Robert W. Pegram and Nigel P. Stocks |
Abstract: | Objective: To review the literature for any promising strategies for the primary care management of mild-to-moderate asthma and chronic obstructive pulmonary disease (COPD) in adults. Methods: Using “MeSH” terms for COPD, asthma and primary health care, we conducted an extensive literature search for relevant meta-analyses, systematic reviews, narrative reviews, reports and individual studies. Grey literature was also included. We chose a narrative review approach because of substantial heterogeneity of study designs in the literature. Results: 1119 articles of potential relevance were retained, of which 246 were included in our review. There was insufficient evidence to determine whether general practitioners with a special interest (GPwSI) in respiratory care improved the diagnosis and management of mild-to-moderate COPD. An asthma service involving GPwSI increased respiratory drug costs but reduced the costs for less specific drugs. No clear benefit has been shown for practice nurse-run asthma clinics in primary care compared with usual care in altering asthma morbidity, quality of life, lung function or medication use. Evidence to determine the effectiveness of practice nurse-run COPD clinics could not be found. Self-management education, GP review and action plans may produce short-term benefits for asthma patients, particularly those with moderate-to-severe disease, but the evidence for a similar approach to patients with mild-to-moderate COPD is equivocal. There has been poor uptake of respiratory clinical guidelines relevant to primary care — partly because most guidelines are based on moderate-to-severe disease. Spirometry programs in primary care are useful for differential diagnosis of asthma and COPD. Spirometry may alter the management of mild asthma, but there is a lack of evidence that it alters the management of COPD in primary care. Conclusion: The role of primary health care in management of mild-to-moderate asthma and COPD requires further investigation using randomised controlled trials. |
Keywords: | Humans Asthma Pulmonary Disease, Chronic Obstructive Models, Theoretical Primary Health Care |
DOI: | 10.5694/j.1326-5377.2008.tb01744.x |
Published version: | http://www.mja.com.au/public/issues/188_08_210408/cra11057_fm.html |
Appears in Collections: | Aurora harvest 5 General Practice publications |
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