Post-hospitalisation asthma management in primary care: a retrospective cohort study

Abstract

Abstract Background Clinical guidelines recommend that patients admitted to hospital for asthma attacks are reviewed in primary care following hospital discharge. Aim We evaluated post-hospitalisation asthma management in primary care and its associations with patient characteristics. Design and setting A retrospective cohort study was performed using English primary care data from the Clinical Practice Research Datalink Aurum database and linked Hospital Episode Statistics Admitted Patient Care data. Method Patients with asthma aged ≥5 years who had at least one asthma-related hospitalisation from 1st January 2017 to 31st December 2019 were included. Primary outcome was a composite of any of the following delivered in primary care within 28 days from hospital discharge: asthma review, asthma management plan, asthma medication prescriptions, demonstration of inhaler technique, or smoking cessation counselling. The association between patient characteristics and delivery of clinical care was assessed using logistic regression. Results The study included 17,457 patients. 60% had received the primary outcome within 28 days of hospital discharge. 13% received an asthma review, 8% an asthma management plan, 57% an asthma medication, 8% a demonstration of inhaler technique, and 1.2% (of smokers) smoking cessation counselling. This care was less likely to be received by patients from black ethnic minority groups (27-54% relative reduction, depending on age group). By contrast, previous prescriptions of short-acting bronchodilators were associated with an increased likelihood of the primary outcome. Conclusion A significant proportion of patients do not receive timely follow-up in primary care following asthma-related hospital admissions, particularly among patients from black ethnic groups.