| アブストラクト | Objective: To improve asthma morbidity and mortality in the UK, national asthma guidelines recommend referral to specialist care for the following high-risk groups, after a hospital admission for asthma, >/=3 courses of oral corticosteroids (OCS) in 12 months, an incident high-dose inhaled corticosteroid (ICS) prescription or addition of a fourth asthma drug to a patient's maintenance regimen. We sought to assess the prevalence and temporal change of referrals to identify unmet needs. Methods: We used UK electronic healthcare records, 2006-2017, to identify high-risk asthma patients managed within primary care. Referrals to respiratory clinics in secondary care were measured, within 3 months before or 6 months after, an incident ICS, third OCS in a year, or fourth asthma drug; or 12 months after a hospital admission for asthma. A nested case-control and conditional logistic regression was used to evaluate factors associated with receiving a referral. Results: A total of 246,116 asthma patients were eligible. There was a slight increase in secondary care referrals from 2014 onwards but the percentage remained low with <20% in each high-risk group referred for specialist care. The factors in the past year that were most strongly associated with receiving a referral were a hospital admission or A&E visit for asthma, >/=3 OCS courses, >/=2 add-on drugs, or high-dose ICS prescription. Conclusions: The majority of high-risk asthma patients were not referred for specialist care, as recommended by national guidelines. Compared to other risk factors, those admitted to hospital were most likely to receive a referral. Abbreviations A&E accident and emergency BTS British Thoracic Society CPRD Clinical Practice Research Datalink COPD chronic obstructive pulmonary disease GP general practice HES Hospital Episode Statistics ICS inhaled corticosteroids IMD Index of Multiple Deprivation ISAC Independent Scientific Advisory Committee LABA long-acting beta-agonist LAMA long-acting antimuscarinic LTRA leukotriene receptor antagonist NICE National Institute for Health and Care NRAD National Review of Asthma Deaths OCS oral corticosteroids SIGN Scottish Intercollegiate Guideline Network. |
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