Predictors of the quality of care for asthma in general practice: an observational study.

摘要

BACKGROUND: Asthma is a common and important health condition in the UK, predominantly managed in primary care. Little is known about how characteristics of practices and patients are associated with achievement of quality indicators (QIs) for asthma. OBJECTIVE: To measure the recorded quality of primary care for asthma and to assess whether quality of care differed by patient and practice characteristics. METHODS: Medical records were examined for 253 randomly selected asthma patients from 18 general practices in England. Quality of care was assessed against seven predetermined QIs. Logistic regression models were used to test variations in quality of care by age, gender, patient postcode deprivation rank, practice size and time point. RESULTS: There was substantial variation in achievement of individual QIs (range 39-97%). Participants whose postcodes were in the most deprived areas were more likely to be asked about difficulties sleeping [odds ratios (ORs) 1.7, 95% confidence interval (CI) 1.2-2.5] or whether asthma interfered with daily activities (OR 1.8, CI 1.2-2.7) than those from middle or least deprived postcode areas. QIs were more likely to be achieved in 2005 than 2003 (ORs 4.4, 2.4, 3.0). There were no significant differences by other characteristics. CONCLUSIONS: Great variations exist in the quality of primary care for asthma and considerable scope for improvement. Asthma care improved over time. The preliminary findings that quality of asthma care varied with deprivation support the idea that primary care may be targeting care to those in most need. However, variations were small and only significant for two QIs.