BTS statement on criteria for specialist referral, admission, discharge and follow-up for adults with respiratory disease

Pantin, C. F. A.

doi:10.1136/thx.2007.087627

Cited by 24 publications

(11 citation statements)

References 14 publications

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“…Hospital admission is often used as quality parameter [24,25]. The low admission rates in our study show that it may be necessary to reconsider the use of hospital admission as a quality parameter for asthma treatment, and that for effectiveness studies in primary care settings admission rates should no longer be used as a quality end-point.…”

Section: Discussionmentioning

confidence: 85%

Low hospital admission rates for respiratory diseases in children

et al. 2010

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BackgroundPopulation-based data on hospital admissions for children aged 0-17 years concerning all respiratory diseases are scarce. This study examined hospital admissions in relation to the preceding consultations in general practice in this age group.MethodsData on children aged 0-17 years with respiratory diseases included in the Second Dutch National Survey of General Practice (DNSGP-2) were linked to all hospital admissions in the Dutch National Medical Registration. Admission rates for respiratory diseases were calculated. Data were analysed using multivariate logistic regression.ResultsOf all 79,272 children within the DNSGP-2, 1.8% were admitted to hospital for any respiratory diagnosis. The highest admission rates per 1000 children were for chronic disease of tonsils and adenoids (12.9); pneumonia and influenza (0.97); and asthma (0.92). Children aged 0-4 years and boys were admitted more frequently. Of children with asthma, 2.3% were admitted for respiratory diseases. For asthma, admission rates varied by urbanisation level: 0.47/1000 children/year in cities with ≤ 30,000 inhabitants, 1.12 for cities with ≥ 50,000 inhabitants, and 1.73 for the three largest cities (p = 0.002). Multivariate logistic regression showed that within two weeks after a GP consultation, younger age (OR 0.81, 95% CI 0.76-0.88) and more severe respiratory diseases (5.55, 95% CI 2.99-8.11) predicted hospital admission.ConclusionsChildren in the general population with respiratory diseases (especially asthma) had very low hospital admission rates. In urban regions children were more frequently admitted due to respiratory morbidity. For effectiveness studies in a primary care setting, hospital admission rates should not be used as quality end-point.

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Section: Discussionmentioning

confidence: 85%

Low hospital admission rates for respiratory diseases in children

et al. 2010

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“… 3 9 0 Outpatient follow-up The PBMA process identified that the health board spends a considerable proportion of the budget on outpatient follow-up attributed to a new to follow-up ratio, which is higher than other areas. If the current follow-up ratio was modified in accordance with guidelines available, 14 resources could be released from outpatient services. The panel wished to improve the current outpatient follow-up ratio by following guidelines.…”

Section: Resultsmentioning

confidence: 99%

Use of programme budgeting and marginal analysis as a framework for resource reallocation in respiratory care in North Wales, UK

et al. 2015

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BackgroundSince the global financial crisis, UK NHS spending has reduced considerably. Respiratory care is a large cost driver for Betsi Cadwaladr University Health Board, the largest health board in Wales. Under the remit of ‘prudent healthcare’ championed by the Welsh Health Minister, a Programme Budgeting Marginal Analysis (PBMA) of the North Wales respiratory care pathway was conducted.MethodsA PBMA panel of directors of medicines management, therapies finance, planning, public health and healthcare professionals used electronic voting to establish criteria for decision-making and vote on candidate interventions in which to disinvest and invest.ResultsA sum of £86.9 million was spent on respiratory care in 2012–13. Following extensive discussion of 13 proposed candidate interventions facilitated by a chairperson, 4 candidates received recommendations to disinvest, 7 to invest and 2 to maintain current activity. Marginal analysis prioritized mucolytics and high antibiotic prescribing as areas for disinvestment, and medicines waste management and pulmonary rehabilitation for investment.ConclusionsThis exercise demonstrates the potential for health boards to use evidence-based approaches to reach potentially controversial disinvestment and investment decisions. Initial progress has begun with communication from the Medical Director in relation to the disinvestment in mucolytics prescribing and possible redirection of funding options being explored.

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“…Elderly patients are more likely to require admission during an exacerbation, simple exacerbations can be complicated by social isolation and lack of support or by acute delirium. 19 …”

Section: Treatmentmentioning

confidence: 99%

Non-cystic fibrosis bronchiectasis in the elderly: current perspectives

Quinn

Hill

2018

CIA

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Bronchiectasis is a chronic lung disease with permanently damaged airways predisposing to recurrent respiratory tract infections. There is an increasing prevalence of bronchiectasis in the elderly, affecting approximately 10 patients per 1,000 population. Studies have shown that older, frailer patients tend to have a more severe and symptomatic disease, with those aged 80 and above with worse quality of life, increased hospitalization and increased mortality. These patients will be encountered by clinicians working in all aspects of elderly care. This review covers the various investigations and aspects of treatment for bronchiectasis and how they may be utilized in a more older and generally frailer population.

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BTS statement on criteria for specialist referral, admission, discharge and follow-up for adults with respiratory disease

Cited by 24 publications

References 14 publications

Low hospital admission rates for respiratory diseases in children

Low hospital admission rates for respiratory diseases in children

Use of programme budgeting and marginal analysis as a framework for resource reallocation in respiratory care in North Wales, UK

Non-cystic fibrosis bronchiectasis in the elderly: current perspectives

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