The Pharmaceutical Journal
Vol 270 No 7239 p327
8 March 2003

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Asthma review can be done over the telephone — but is it patient-focused?

Telephone consultations could be an efficient way of reviewing patients with symptomatic asthma, say the authors of a new trial. But a consultant respiratory pharmacist has questioned how patient-focused such an intervention is.

The authors of the study compared the acceptability and effectiveness of telephone review and face-to-face consultation with the asthma nurse in four general practices in England. The trial involved 278 adults who had not been reviewed in the previous 11 months.

Patients who agreed to take part were sent a letter either telling them to expect a call from the asthma nurse or inviting them to make an appointment to see the nurse in the surgery. Of 137 people randomised to telephone consultation, 101 were reviewed (74 per cent), compared with 68 of the 141 (48 per cent) randomised to consultation in the surgery.

Quality of life scores and symptom scores measured three months after randomisation were similar in the two groups, as was patients' satisfaction with the consultation. Telephone consultations were on average 10 minutes shorter than reviews held in the surgery.

"Telephone consultations enable more people with asthma to be reviewed, without clinical disadvantage or loss of satisfaction. A shorter duration means that telephone consultations are likely to be an efficient option in primary care for routine review of asthma," the authors conclude (BMJ 2003;326:477).

Could telephone review of asthma patients also be useful for pharmacists? Consultant respiratory pharmacist Anna Murphy, from Glenfield Hospital, Leicester, sees only a limited place for it. "For concordance issues, it is much better to speak to the patient face to face," she says.

"Using the telephone is a shortcut to review more patients but I would question the quality of the information you get from it. The authors suggest that telephone conversations may be more goal-focused and quicker, but are they patient-focused?"

Ms Murphy does sometimes telephone patients to see how they are getting on after changes in therapy, but this is only ever an interim measure.

There is certainly a problem in getting asthma patients to clinics for review, since many patients are young and have work commitments. This is where Ms Murphy sees opportunities for the community pharmacist. "With pharmacies being open at weekends, there is an ideal opportunity for asthma patients to see the pharmacist for a review of their treatment."