Childhood asthma: healthcare resource utilisation in those with and without a diagnosis of the condition.

AIM: To examine healthcare utilisation and the direct financial costs in providing medical care to a population of children aged 5-15 years with respiratory complaints. Secondarily, to assess whether these costs depended upon having specific asthma diagnosis or not. METHOD: A postal respiratory questionnaire was sent to the parents or guardians of all children registered with two general practices. A search of the general practice medical records over a 2-year reference period was made for a stratified random sample and results are presented for 488 children aged 5-15 years. RESULTS: The cost of primary care lower respiratory tract consultations in children with 4-5 symptoms/risk factors was pounds sterling 17.02 per patient per year for those with a previous diagnosis of asthma compared with pounds sterling 6.08 per patient per year for those with the same number of symptoms but no diagnosis (t = -4.446, P<0.001). The cost of primary care lower respiratory consultations in those with no GP diagnosis of asthma and no symptoms/risk factors was pounds sterling 2.25 per patient per year. CONCLUSIONS: Studies, which fail to include the costs associated with treating children with respiratory symptoms but without a formal diagnosis, will seriously underestimate the costs of treating asthmatic children.

Identification of adults with symptoms suggestive of obstructive airways disease: validation of a postal respiratory questionnaire.

BACKGROUND: Two simples scoring systems for a self-completed postal respiratory questionnaire were developed to identify adults who may have obstructive airways disease. The objective of this study was to validate these scoring systems. METHOD: A two-stage design was used. All adults in two practice populations were sent the questionnaire and a stratified random sample of respondents was selected to undergo full clinical evaluation. Three respiratory physicians reviewed the results of each evaluation. A majority decision was reached as to whether the subject merited a trial of obstructive airways disease medication. This clinical decision was compared with two scoring systems based on the questionnaire in order to determine their positive predictive value, sensitivity and specificity. RESULTS: The PPV (positive predictive value) of the first scoring system was 75.1% (95% CI 68.6-82.3), whilst that of the second system was 82.3% (95% CI 75.9-89.2). The more stringent second system had the greater specificity, 97.1% (95% CI 96.0-98.2) versus 95.3% (95% CI 94.0-96.7), but poorer sensitivity 46.9% (95% CI 33.0-66.8) versus 50.3% (95% CI 35.3-71.6). CONCLUSION: This scoring system based on the number of symptoms/risk factors reported via a postal questionnaire could be used to identify adults who would benefit from a trial of treatment for obstructive airways disease.

The Impact of Respiratory Symptoms on Healthcare Utilisation: The Primary and Secondary Care Interface.

BACKGROUND: There is evidence that the prevalence of asthma is increasing but little is known about the contribution made by respiratory illness to the combined workload of primary and secondary healthcare. AIM: To examine the relationship between self-reported respiratory symptoms in adults and health care utilisation. METHODS: Two general practice populations received a postal questionnaire regarding respiratory symptoms in 1993. A random sample of 736 adult respondents was stratified according to number of positive responses to six key questions (to indicate likelihood of asthma diagnosis). Their records were searched for utilisation of healthcare services, to include both primary and secondary sectors. RESULTS: Positive responses to the key questions were associated with increased relative risk of having a GP consultation, home visit, investigation and prescription issued for lower respiratory problems. Those with higher numbers of positive responses had increased relative risk of out-patient or A & E attendance as well as in-patient admission. CONCLUSION: The principal finding of this study is that respiratory symptoms are significantly positively associated with utilisation of health care services for lower and upper respiratory problems. This study provides quantitative evidence of the interface between primary and secondary care in two general practice populations. It provides a method for predicting health care utilisation in both primary and secondary sectors based on reported respiratory symptoms.