Assessing the performance of general practices caring for patients with asthma
Background. General practitioners (GPs) have had to record information about chronic disease management and send this to the health authorities since the introduction of the new contract in 1990. Aim. To discover the relationship between practice emergency admission rates for asthma and the characteristics of the practice's patients and chronic disease management programme. Method. This was an ecological study comparing practice emergency admission rates of asthma by general practice with the practice's performance in measuring the prevalence, peak flow, and number of patients on regular prophylaxis. In addition, prescribing analysis and costing (PACT) data and census linkage were used to assign social class to patients and, when aggregated, to practices. The practice admission rate was correlated against each of these variables and then the relationships were explored in multiple linear regressions. Results. A high rate of admission in practices was correlated with deprivation of the patients, in the form of a practice Townsend score (r = 0.33, P = 0.003), and also with poorer prescribing, measured by the preventer-reliever ratio (r = -0.38, P = 0.001). Regression analysis showed that the relationship between good prescribing and low admission rates was not explained by confounding variables. Only 32% of the variation in admission rates between practices was explained by the regression equation. None of the variables recorded in the annual report were significantly related to admission rates. Conclusion. Annual reports from the practice to the health authority are unhelpful in monitoring general practice performance, but prescribing, as measured by the preventer-reliever ratio, and hospital admission rates have limited usefulness.