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

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. The 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. 10,515 (60.2%) patients received the primary outcome within 28 days of hospital discharge. 2311 (13.2%) received an asthma review, 1459 (8%) an asthma management plan, 9996 (57.3%) an asthma medication, 1500 (8.6%) a demonstration of inhaler technique, and 52 (1.2% of smokers) had smoking cessation counselling. Patients from black ethnic minorities received less of this care (27-54% lower odds, depending on age). However, short-acting bronchodilator prescriptions in the previous year 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 hospitalisations, particularly among black ethnic groups.