School children's views of asthma services in two contrasting general practice populations

Abstract

The Government has identified school as a key setting for reducing health inequalities, but many schools fail to support pupils with medical needs, such as asthma. This paper describes a survey designed to elicit the views of asthmatic children in two contrasting general practitioner (GP) practice populations regarding their asthma care, including support at school. A questionnaire was sent to all asthmatic children aged 4–17 in two practices during August 2002. The population in Practice 1 (P1) was mainly white, suburban, with pockets of deprivation, and had a long-established asthma clinic. Practice 2 (P2) had an almost exclusively Asian population, was close to the town centre and did not have a regular asthma clinic. Children from P1 had a higher response rate, 69 of 124 (55%) (compared with 21 of 107, 21% in P2), they also reported lower symptom levels and less use of hospital services, particularly paediatric outpatient clinics. Nurses were perceived as the main source of information and support in P1 (68%), followed by doctors (43%). In P2 this was reversed, nurses being identified by 33%, doctors by 62%. If an asthma problem occurred at school, the vast majority said that they would ask a teacher for help, but they also said that school staff needed more information to help pupils with asthma. These results mirror what is already known from large survey data regarding inequality of access to asthma services. In view of the national shortage of GPs it would seem prudent for Primary Care Organizations to increase investment in delivery of comprehensive asthma management services by practice nurses, school health nurses and pharmacists. This should include support for teachers, who are being expected to cope with increasing numbers of children with medical needs in schools.