Asthma care in Darley Dale: general practitioner audit.

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Abstract
OBJECTIVE--To complete a first audit cycle of asthma care in Darley Dale after starting an asthma clinic. DESIGN--Pre-clinic (1989) and post-clinic (1990) analysis of medical records of patients with asthma. SETTING--A group practice in Derbyshire. PATIENTS--161 pre-clinic, 238 post-clinic patients with asthma. MAIN OUTCOME MEASURES--Term "asthma" in the patient's computerised problem list, recording of peak expiratory flow rate, smoking history, clinical review, medication, and hospital admissions for asthma. RESULTS--There were significant improvements post-clinic with respect to the term "asthma" in the computer file (1989, 93/161 (58%); 1990, 233/238 (98%) (difference 0.40; 95% confidence interval 0.32 to 0.48)); at least one peak flow measurement (1989, 24/161 (15%); 1990, 143/238 (60%) (0.45; 0.37 to 0.53)); three or more peak flow measurements (1989, 15/161 (9%); 1990, 40/238 (17%) (0.08; 0.02 to 0.14)); and smoking history (1989, 24/161 (15%); 1990, 133/238 (56%) (0.41; 0.33 to 0.49)). There were no significant differences post-clinic with respect to asthma reviewed at least once (1989, 61/161 (38%); 1990, 74/238 (31%) (0.07; -0.03 to 0.17)); recording long term medication; treating acute asthma; or ratio of average to best peak flow rate of 38 patients who had one or more measurements (1989, 31/38 (82%); 1990, 34/38 (89%) (0.08; -0.08 to 0.24)). CONCLUSIONS--Setting up an asthma clinic resulted in better recording of data relevant to patients with asthma. However, objective improvement in patients' asthma could not be detected. Renewed emphasis on prophylactic measures may result in measurable improvement in these patients' asthma in the future.