There are few reports of primary care initiatives designed to improve management of asthma patients who are at risk of adverse outcomes. Aim: To assess the impact on emergency treatments, service use, and costs, of introducing an at-risk asthma register in a general practice surgery. Methods: Asthma patients demonstrating characteristics associated with adverse outcomes were added to an at-risk register. Tags were placed in patients' records and practice staff were trained to ensure their

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... riate recognition and management. Data were retrospectively extracted from the notes of 26 identified at-risk patients, as well as 26 age-, sex-, and treatment-matched controls with asthma, for one year before and after the introduction of the register. Implementation and service use costs were estimated. Results: Before introduction of the register, more 'at-risk' than control patients were hospitalised (3 vs. 0), attended the accident and emergency (A&E) department (1 vs. 0), and were nebulised (4 vs. 0), for asthma. Significantly higher numbers also used out-of-hours services, received oral steroids, attended their general practitioner (GP), and failed to attend scheduled clinics for asthma (all p < 0.025). After introduction of the register, no at-risk patients were admitted or attended A&E. Although differences in the numbers receiving oral steroids remained (p = 0.05), other differences disappeared. There were notably greater reductions in overall numbers of admissions, out-of-hours attendances, GP attendances, courses of steroids, and total costs associated with service use, amongst 'at-risk' as compared to control patients. Conclusions: An at-risk asthma register is a low cost initiative warranting further evaluation, since it may facilitate appropriate service use in a vulnerable and costly patient group.