Clinical implications of the Royal College of Physicians three questions in routine asthma care

a real-life validation study

Hilary Pinnock, Chris Burton, Stephen Campbell, Kevin Gruffydd-Jones, Kerin Hannon, Gaylor Hoskins, Helen Lester, David Price, Christopher David Burton

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

BACKGROUND: Annual recording of the Royal College of Physicians three questions (RCP3Q) morbidity score is rewarded within the UK ‘pay-for-performance’ Quality and Outcomes Framework. AIMS: To investigate the performance of the RCP3Qs for assessing control in real-life practice compared with the validated Asthma Control Questionnaire (ACQ) administered by self-completed questionnaire. METHODS: We compared the RCP3Q score extracted from a patient’s computerised medical record with the ACQ self-completed after the consultation. The anonymous data were paired by practice, age, sex, and dates of completion. We calculated the sensitivity and specificity of the RCP3Q scale compared with the threshold for good/poor asthma control (ACQ >1). RESULTS: Of 291 ACQ questionnaires returned from 12 participating practices, 129 could be paired with complete RCP3Q data. Twentyfive of 27 patients who scored zero on the RCP3Q were well controlled (ACQ <1). An RCP3Q score >1 predicted inadequate control (ACQ >1) with a sensitivity of 0.96 and specificity of 0.34. Comparable values for RCP3Q>2 were sensitivity 0.50 and specificity 0.94. The intraclass correlation coefficient of 0.13 indicated substantial variability between practices. Exacerbations and use of reliever inhalers were moderately correlated with ACQ (Spearman’s rho 0.3 and 0.35) and may reflect different aspects of control. CONCLUSIONS: In routine practice, an RCP3Q score of zero indicates good asthma control and a score of 2 or 3 indicates poor control. An RCP3Q score of 1 has good sensitivity but poor specificity for suboptimal control and should provoke further enquiry and consideration of other aspects of control such as exacerbations and use of reliever inhalers.

Original languageEnglish
Pages (from-to)288-294
Number of pages7
JournalPrimary Care Respiratory Journal
Volume21
Issue number3
DOIs
Publication statusPublished - 2012

Fingerprint

Validation Studies
Asthma
Physicians
Sensitivity and Specificity
Nebulizers and Vaporizers
Computerized Medical Records Systems
Incentive Reimbursement
Surveys and Questionnaires
Referral and Consultation
Morbidity

Keywords

  • asthma control
  • asthma reviews
  • primary care
  • Royal College of Physicians three questions
  • validation

Cite this

Clinical implications of the Royal College of Physicians three questions in routine asthma care : a real-life validation study. / Pinnock, Hilary; Burton, Chris; Campbell, Stephen; Gruffydd-Jones, Kevin; Hannon, Kerin; Hoskins, Gaylor; Lester, Helen; Price, David; Burton, Christopher David.

In: Primary Care Respiratory Journal, Vol. 21, No. 3, 2012, p. 288-294.

Research output: Contribution to journalArticle

Pinnock, Hilary ; Burton, Chris ; Campbell, Stephen ; Gruffydd-Jones, Kevin ; Hannon, Kerin ; Hoskins, Gaylor ; Lester, Helen ; Price, David ; Burton, Christopher David. / Clinical implications of the Royal College of Physicians three questions in routine asthma care : a real-life validation study. In: Primary Care Respiratory Journal. 2012 ; Vol. 21, No. 3. pp. 288-294.
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abstract = "BACKGROUND: Annual recording of the Royal College of Physicians three questions (RCP3Q) morbidity score is rewarded within the UK ‘pay-for-performance’ Quality and Outcomes Framework. AIMS: To investigate the performance of the RCP3Qs for assessing control in real-life practice compared with the validated Asthma Control Questionnaire (ACQ) administered by self-completed questionnaire. METHODS: We compared the RCP3Q score extracted from a patient’s computerised medical record with the ACQ self-completed after the consultation. The anonymous data were paired by practice, age, sex, and dates of completion. We calculated the sensitivity and specificity of the RCP3Q scale compared with the threshold for good/poor asthma control (ACQ >1). RESULTS: Of 291 ACQ questionnaires returned from 12 participating practices, 129 could be paired with complete RCP3Q data. Twentyfive of 27 patients who scored zero on the RCP3Q were well controlled (ACQ <1). An RCP3Q score >1 predicted inadequate control (ACQ >1) with a sensitivity of 0.96 and specificity of 0.34. Comparable values for RCP3Q>2 were sensitivity 0.50 and specificity 0.94. The intraclass correlation coefficient of 0.13 indicated substantial variability between practices. Exacerbations and use of reliever inhalers were moderately correlated with ACQ (Spearman’s rho 0.3 and 0.35) and may reflect different aspects of control. CONCLUSIONS: In routine practice, an RCP3Q score of zero indicates good asthma control and a score of 2 or 3 indicates poor control. An RCP3Q score of 1 has good sensitivity but poor specificity for suboptimal control and should provoke further enquiry and consideration of other aspects of control such as exacerbations and use of reliever inhalers.",
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AU - Pinnock, Hilary

AU - Burton, Chris

AU - Campbell, Stephen

AU - Gruffydd-Jones, Kevin

AU - Hannon, Kerin

AU - Hoskins, Gaylor

AU - Lester, Helen

AU - Price, David

AU - Burton, Christopher David

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N2 - BACKGROUND: Annual recording of the Royal College of Physicians three questions (RCP3Q) morbidity score is rewarded within the UK ‘pay-for-performance’ Quality and Outcomes Framework. AIMS: To investigate the performance of the RCP3Qs for assessing control in real-life practice compared with the validated Asthma Control Questionnaire (ACQ) administered by self-completed questionnaire. METHODS: We compared the RCP3Q score extracted from a patient’s computerised medical record with the ACQ self-completed after the consultation. The anonymous data were paired by practice, age, sex, and dates of completion. We calculated the sensitivity and specificity of the RCP3Q scale compared with the threshold for good/poor asthma control (ACQ >1). RESULTS: Of 291 ACQ questionnaires returned from 12 participating practices, 129 could be paired with complete RCP3Q data. Twentyfive of 27 patients who scored zero on the RCP3Q were well controlled (ACQ <1). An RCP3Q score >1 predicted inadequate control (ACQ >1) with a sensitivity of 0.96 and specificity of 0.34. Comparable values for RCP3Q>2 were sensitivity 0.50 and specificity 0.94. The intraclass correlation coefficient of 0.13 indicated substantial variability between practices. Exacerbations and use of reliever inhalers were moderately correlated with ACQ (Spearman’s rho 0.3 and 0.35) and may reflect different aspects of control. CONCLUSIONS: In routine practice, an RCP3Q score of zero indicates good asthma control and a score of 2 or 3 indicates poor control. An RCP3Q score of 1 has good sensitivity but poor specificity for suboptimal control and should provoke further enquiry and consideration of other aspects of control such as exacerbations and use of reliever inhalers.

AB - BACKGROUND: Annual recording of the Royal College of Physicians three questions (RCP3Q) morbidity score is rewarded within the UK ‘pay-for-performance’ Quality and Outcomes Framework. AIMS: To investigate the performance of the RCP3Qs for assessing control in real-life practice compared with the validated Asthma Control Questionnaire (ACQ) administered by self-completed questionnaire. METHODS: We compared the RCP3Q score extracted from a patient’s computerised medical record with the ACQ self-completed after the consultation. The anonymous data were paired by practice, age, sex, and dates of completion. We calculated the sensitivity and specificity of the RCP3Q scale compared with the threshold for good/poor asthma control (ACQ >1). RESULTS: Of 291 ACQ questionnaires returned from 12 participating practices, 129 could be paired with complete RCP3Q data. Twentyfive of 27 patients who scored zero on the RCP3Q were well controlled (ACQ <1). An RCP3Q score >1 predicted inadequate control (ACQ >1) with a sensitivity of 0.96 and specificity of 0.34. Comparable values for RCP3Q>2 were sensitivity 0.50 and specificity 0.94. The intraclass correlation coefficient of 0.13 indicated substantial variability between practices. Exacerbations and use of reliever inhalers were moderately correlated with ACQ (Spearman’s rho 0.3 and 0.35) and may reflect different aspects of control. CONCLUSIONS: In routine practice, an RCP3Q score of zero indicates good asthma control and a score of 2 or 3 indicates poor control. An RCP3Q score of 1 has good sensitivity but poor specificity for suboptimal control and should provoke further enquiry and consideration of other aspects of control such as exacerbations and use of reliever inhalers.

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KW - asthma reviews

KW - primary care

KW - Royal College of Physicians three questions

KW - validation

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DO - 10.4104/pcrj.2012.00052

M3 - Article

VL - 21

SP - 288

EP - 294

JO - Primary Care Respiratory Journal

JF - Primary Care Respiratory Journal

SN - 1475-1534

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ER -