A randomized controlled trial of follow-up of patients discharged from the hospital following acute asthma: best performed by specialist nurse or doctor?

OBJECTIVE

To evaluate whether follow-up of patients recently discharged from the hospital as a result of acute asthma can be adequately provided by a respiratory specialist nurse compared to a respiratory doctor.

DESIGN

Single center, prospective, randomized controlled trial.

SETTING

District general hospital in the United Kingdom.

PARTICIPANTS

One hundred fifty-four of 373 eligible patients admitted with acute asthma were enrolled into the study from October 2000 to October 2003. All patients > 16 years of age were eligible for the study. Patients with COPD were excluded.

INTERVENTION

Patients were randomly assigned to receive an initial 30-min follow-up clinic appointment within 2 weeks of hospital discharge with either a specialist nurse or respiratory doctor. This comprised a medical review, patient education, and a self-management asthma plan. Further follow-up was then arranged as was deemed appropriate by the corresponding doctor or nurse. All patients were asked to attend a 6-month appointment.

MEASUREMENTS

The primary outcome was the number of exacerbations within 6 months of hospital admission. Secondary outcome variables were change in peak flow, quality of life (using the St. George Respiratory Questionnaire (SGRQ) and the Asthma Questionnaire 20 [AQ20]), and clinic attendance.

RESULTS

Outcome data were available for 66 patients in the doctor group and 70 patients in the nurse group. There was no difference in the number of patients with exacerbations in the nurse group compared to the doctor group (45.6% vs 49.2%; odds ratio, 0.86; 95% confidence interval [CI], 0.44 to 1.71; p = 0.674). However, a significant proportion of patients in both groups had exacerbations despite hospital outpatient follow-up. There was no difference in quality of life (p = 0.285; mean difference, 0.78; 95% CI, - 0.64 to 2.19 for the AQ20; and p = 0.891; mean difference, 1.08; 95% CI, - 5.05 to 7.21 for SGRQ) or change in peak flow (mean difference between nurse and doctor groups, 1.39 (95% CI, - 3.84 to 6.63; p = 0.122) at 6 months.

CONCLUSIONS

Follow-up care by a nurse specialist for patients admitted with acute asthma can be delivered equivocally with comparable safety and effectiveness to that given by a doctor.