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Action on asthma

Action on asthma

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Eight out of 10 people with asthma are not receiving care that meets basic standards and prevents life-threatening asthma attacks. What can commissioners do to aid the management of this long-term condition

New research from Asthma UK shows that eight out of 10 people with asthma are not receiving care that meets the most basic clinical standards. This is despite the fact that good routine asthma care prevents life-threatening asthma attacks and needless hospital admissions.

These findings come more than six months after the National Review of Asthma Deaths UK (NRAD) found that a shocking two-thirds of asthma deaths could be prevented with better routine care.

Asthma UK is urging CCGs to deliver care that meets the NICE Quality Standard for asthma and has launched a new suite of online resources to help them do this, including service improvement tools and best practice examples that have proved successful at improving outcomes in asthma care at a local level. Asthma is one of the most common long-term conditions in the UK, affecting one in 11 people. Every 10 seconds someone is having a potentially life-threatening asthma attack, and asthma attacks kill as many as three people a day.

Yet delivering the basics in asthma care – including a written asthma action plan, an annual asthma review and a check of inhaler technique - are proven to keep people with asthma well and out of hospital.

Asthma UK’s research shows that seven out of 10 people with asthma are not receiving one of the most fundamental aspects of asthma care – a written asthma action plan – yet without one, people with asthma are four times more likely to be admitted to hospital.

Annual asthma reviews also play a key role in supported self-management for people with asthma, providing an opportunity to review medication and check inhaler technique. This is essential because up to a third of people with asthma make mistakes with their inhalers that are significant enough to reduce the effectiveness of their treatments.

In terms of cost, an emergency admission for asthma is 23 times the cost of an annual asthma review, yet the research highlights that almost a quarter of people with asthma have not had an annual review in the last year.

Improvements in routine asthma care have been shown to significantly reduce hospital admissions, leading to significant cost savings for CCGs, as shown in a number of best practice examples now featured on Asthma UK’s website. Wakefield and Tower Hamlets CCGs are just two of the CCGs which have pledged to implement the NICE Quality Standard for Asthma.

Life-threatening asthma attacks can be prevented if commissioners and healthcare professionals simply get the basics right. To access more examples and tools to support you to deliver asthma care that meets basic clinical standards please visit www.asthma.org.uk/takeaction-hub.  

What’s working in Wakefield

The Public health respiratory team in NHS Wakefield worked with Mid Yorkshire Hospitals Trust to implement an asthma care bundle, aimed at improving care for people with asthma and supporting effective discharge planning.

The care bundle was supported by a Commissioning for Quality and Innovation (CQUIN) scheme and has acted as a catalyst for the wider development of the asthma service.

The project included diagnostic work, process mapping to understand the current pathway and a programme of staff training. A care bundle was developed based on British Thoracic Society  and Scottish Intercollegiate Guidelines Network (BTS/SIGN) guidelines which included an action plan, follow-up by a GP or specialist, checking inhaler technique, and training for healthcare professionals. 

The project aimed to secure a reduction in admissions and readmissions within 28 days of discharge, as well as improve the quality and consistency of asthma care delivered in emergency departments. By the end of 2012, 96% of patients had an asthma action plan at discharge, compared to 8% at the start of 2011, and asthma readmissions within 28 days fell from five per month to less than two while total readmissions fell from 109 to 39 a year.

Dr Avijit Biswas, CCG clinical lead for long term conditions, said: “We believed that signing Asthma UK’s pledge demonstrated our commitment to working with patients to achieve improved, more consistent clinical practice and better asthma care. Success in Wakefield has been built on strong relationships and good communication. We work closely with healthcare professionals, patients and carers, which means that services and pathways are developed based on strong evidence and with the commitment of all those involved.”

Tower Hamlets’ take on asthma

Tower Hamlets CCG decided to look at how effectively it is delivering annual reviews in light of increasing asthma admissions rates, significant prescribing of inhalers and the publication of the NRAD report.

In 2014/15 Tower Hamlets CCG will roll out educational support to enable GPs and practice nurses to deliver improved asthma reviews. Providing each practice with a wealth of resources including check lists, review templates, patient invitation letters and training has seen a very high level of engagement from practices.

Additionally, the CCG is incentivising practices to deliver the enhanced annual reviews to 10% of its adult asthma population and ensure each practice has at least two ‘asthma champions’, people who undergo appropriate training and disseminate learning to other practice members. Significant changes in the quality and number of reviews by the end of the financial year 2015 are expected to result in a rise in the number of people with an written asthma action plan, an increase in the use of appropriately prescribed inhaled corticosteroid inhalers, an appropriate reduction in the number of prescribed reliever inhalers and - most importantly - fewer hospital admissions for asthma. 

By December 2014, all practices had undergone the enhanced training, and dissemination commenced the enhanced asthma reviews. At the second quarter, 41% of patients had had an asthma review, been given a written asthma action plan, had their inhaler technique assessed and an asthma control test had been carried out.

Katherine Dickinson is Asthma UK’s campaigns manager.

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