Symptomatic XXXX : attendance and prescribing in general practice.

@entity748 @entity1 @entity2715 @entity565 @entity134 @entity4185 @entity230
Under-prescribing and low attendance continue to be cited as reasons for ongoing @entity565 symptoms in primary care despite marked increases in prescribing and structured care for @entity565 over the past 10 years. The objective of this study was to determine the relationship between continuing @entity565 morbidity and the attendance of and prescribing for symptomatic @entity748 @entity1 in primary care. A random sample of 402 subjects from 801 who reported at least one of six symptoms in the previous month on most or every day were identified from responses to a validated morbidity questionnaire. An analysis of their care over a 2-year period (1 year before and 1 year after the questionnaire) was carried out from their general practice case-notes. Data on 308 @entity1 was available for analysis. Ninety-four per cent of these symptomatic @entity565 @entity1 attended over the 2-year period, with 77% attending for an @entity565 related consultation. Most @entity1 were managed exclusively in primary care. Inhaled @entity230 were prescribed for 78% of @entity1 and high dose inhaled @entity230 (> or = 800 mcg of @entity2715 or equivalent per day) were prescribed for 38%. @entity1 with most symptoms were more likely to be prescribed inhaled @entity230 . Rescue courses of oral @entity230 were prescribed for 29% of @entity1 . Changes in @entity565 medications were recorded for 31% during the study period. @entity4185 ( @entity4185 ) were prescribed for 86% with more than half prescribed MDIs combined with some other delivery device. Elements of structured care were more frequently recorded in @entity1 who reported most symptoms. In conclusion the @entity565 management of the majority of @entity1 in this study was active with high levels of @entity134 prescribing. There appeared to be room to increase prescribing and to improve the structure of care. While @entity1 who were 'symptomatic on @entity230 ' should have had their medications, delivery devices and structured care reviewed regularly many were already on maximal treatment and were therefore likely to remain symptomatic. It is unclear how practitioners could improve morbidity in many of these @entity1 as under-treatment and low attendance seem unlikely to be the principal causes of continuing symptoms.
