For Wales, diagnosis and prescribing data will be queried using t

For Wales, diagnosis and prescribing data will be queried using the SAIL-GP database. PIS information is on prescriptions dispensed, whereas SAIL-GP data are for prescriptions written by GPs, but which may not always have been dispensed. Dispensing is reported on a monthly basis for Wales by drug and GP practices. These totals

can be reconciled against the prescribing by practice in the SAIL data to establish the proportions prescribed and not dispensed and to help with the costing estimates. Although patient-level prescribing data are available in Northern Ireland, diagnosis information is not available; we will therefore not be in a position to conclusively ascertain if treatments have been used for asthma or for other indications. In addition to the above data sources, data on community prescriptions in each of the four countries will be presented detailing numbers of items and costs by BNF category available from Prescription Cost Analysis.17 Out-of-hours Data on out-of-hours GP attendance will be obtained from relevant NHS entities, where available. In England, although an out-of-hours surveillance team exists, a breakdown

by asthma is not available. We have not been able to identify any comparable service in Northern Ireland. Information on calls to out-of-hours using NHS-24, the national telephone triage and advice service for Scotland, is available from 2008 onwards.18 All out-of-hours calls triaged by a nurse using asthma-specific algorithm to support decision-making will be selected. The out-of-hours data in Wales are inconsistently collected across areas and hence will not be used.

Healthcare utilisation in secondary care Outpatient clinics Routine data on attendances in NHS outpatient clinics are available across the four nations; these data are, however, captured under the broader heading of ‘respiratory’ consultations, Dacomitinib and it is therefore not possible to estimate the proportions of these consultations that are for asthma. This will be noted as a major data gap. In an attempt to fill this gap, we will use HSE 2001 for England and SHeS for Scotland from the respective questions: “How many times were you treated by (type of medical professional) for your asthma/wheezing/whistling in the last 12 months?” and “How many times were you treated by a consultant/specialist or other doctor at hospital outpatients for your (asthma/wheezing or whistling) in the last 12 months?”.19–22 For Wales, estimates will be obtained from the SAIL-Outpatient Database from which asthma patients’ GP referral and attendances to outpatient clinics for asthma will be extracted.

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