Ron Neville

Risk factors and costs associated with an asthma attack

BACKGROUND A study was undertaken to identify asthma patients at risk of an attack and to assess the economic impact of treatment strategies. METHODS A retrospective cohort analysis of a representative data set of 12 203 patients with asthma in the UK over a one year period was performed. Logistic multiple regression was used to model the probability of an attack occurring using a set of categorised predictor factors. Health service costs were calculated by applying published average unit costs to the patient resource data. The main outcome measures were attack incidence, health service resource use, drug treatment, and cost estimates for most aspects of asthma related health care. RESULTS Children under five years of age accounted for 597 patients (5%), 3362 (28%) were aged 5–15 years, 4315 (35%) 16–44, 3446 (28%) 45–74, and 483 (4%) were aged over 74 years. A total of 9016 patients (74%) were on some form of prophylactic asthma medication; 2653 (22%) experienced an attack in the year data collection occurred. Overall health care expenditure was estimated at £2.04 million. The average cost per patient who had an attack was £381 compared with £108 for those who did not, an increase of more than 3.5 times. In those aged under five and those over 75 years of age there were no significant markers to identify risk, but both groups were small in size. The level of treatment step in the British Thoracic Society (BTS) asthma guidelines was a statistically significant factor for all other age groups. Night time symptoms were significant in the 5–15, 16–44 and 45–74 age groups, exercise induced symptoms were only significant for the 5–15 age group, and poor inhaler technique in the 16–44 age group. CONCLUSIONS Patients at any treatment step of the BTS asthma guidelines are at risk of an asthma attack, the risk increasing as the treatment step increases. Poorly controlled asthma may have a considerable impact on health care costs. Appropriate targeting of preventive measures could therefore reduce overall health care costs and the growing pressures on hospital services associated with asthma management.

Multi-agent patient representation in primary care

Though multi-agent systems have been explored in a wide variety of medical settings, their role at the primary care level has been relatively little investigated. In this paper, we present a system that is currently being piloted for future rollout in Scotland that employs an industrial strength multi-agent platform to tackle both technical and sociological challenges within primary care. In particular, the work is motivated by several specific issues: (i) the need to widen mechanisms for access to primary care; (ii) the need to harness technical solutions to reduce load not only for general practitioners, but also for practice nurses and administrators; (iii) the need to design and deploy technical solutions in such a way that they fit in to existing professional activity, rather than demanding changes in current practice. With direct representation of individuals in health care relationships implemented in a multi-agent system (with one multi-functional agents representing each patient, doctor, nurse, pharmacist, etc.) it becomes straightforward first to model and then to integrate with existing practice. It is for this reason that the system described here successfully widens access for patients (by opening up novel communication channels of email and SMS texting) and reduces load on the practice (by streamlining communications and semi-automating appointment arrangement). It does this by ensuring that the solution is not imposed on, but rather, integrated with what currently goes on in primary care. Furthermore, with agents responsible for maintaining audit trails for the patients they represent, it becomes possible to see elements of the electronic patient record (EPR) emerging under agent control. This EPR can be extended through structured interaction with the practice system (here, we examine the GPASS system, the market leader in Scotland), to allow rich agent-agent and agent-human interactions. By using multi-agent design and implementation techniques, we have been able to build a solution that integrates both with individuals and extant software to successfully tackle real problems in primary care.

The King Canute GP appointment system

Ron Neville and Simon Austin’s practice decided to stop fighting the tide and let patients have appointments when they wanted. Would they be submerged?

Role of viral infections in exacerbations of asthma. Study supports results of audit by General Practitioners in Asthma Group.

EDITOR,--Sebastian L Johnston and colleagues1 highlight what patients with asthma have been saying for years: that asthma …