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| Author | J K Soler |
| Abstract | To exemplify KM in practice this report will tackle needs assessment and care processes for asthma sufferers, and then GP referrals. The data was collected from 2001 to 2004, covering patients that use the clinic GPs as their primary point of care. Asthma is the most common chronic disease managed. Intervals between encounters in episodes of asthma care indicate that 89% of patients are reviewed at least once a year and 74% every six months. Although follow up seems to be adequate it is difficult to ascertain whether those patients who do not consult regularly do so because of optimal control or non-adherence. It appears that rescue medication (bronchodilators) is prescribed slightly more than inhaled steroids, suggesting poor control. The rapid decay in rates of prescriptions per patient in all drug classes indicates possible non-adherence, or obtaining of repeat prescriptions elsewhere. This information was reviewed during a KM-oriented practice meeting. Team members attempted to define patient needs, review processes of care, and analyse information into tacit (e.g. some doctors are asthmatic) and explicit knowledge (e.g. guidelines). Team approaches to asthma care were reviewed, as well as the roles of the GP, the physiotherapist, and the psychologist regarding difficult cases (e.g. adherence in teenage asthmatics). A new pro-active approach to asthma care was proposed, including: critical review of a local guideline for asthma (Malta Lung Study Group et. al., 1998) within a formal KM process against inherent team member mindlines that may influence practice; regular review of patient symptom scores, medication and attitudes to adherence; the purchase of a lung function test machine; and implementation of a recall system for asthmatics who do not consult at least one a year. It was agreed to time the recall before autumn, when control often worsen. Community pharmacists have been invited to a future meeting to discuss medication adherence and prescription refill. |
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| Journal | Commissioning, Leadership and Management Module, MSc. Primary Health Care, University of Ulster |
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| Pages | - |
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| Key words | Asthma, management, guidelines, prescription, medication, referrals, community pharmacy |