A review of asthma care in 50 general practices in Bedfordshire, United Kingdom

Mark L Levy,Eddie Mcknight,Adedayo Kuku,Inna Pertsovskaya,Fiona Garnett,John Haughney

doi:10.1038/s41533-018-0093-7

Mark L Levy, Eddie Mcknight + Show 4 more

Open Access

https://doi.org/10.1038/s41533-018-0093-7

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Abstract

The United Kingdom (UK) National Review of Asthma Deaths (NRAD) (2011–2014) identified a number of contributory risk factors which had not previously been recognized by those caring for people with asthma. Only one of the 19 NRAD recommendations has so far been implemented nationally, and that only partially, and as yet systems are not in place to identify patients at risk of attacks and dying from asthma. In 2015/2016 Bedfordshire Clinical Commissioning Group (CCG) in England, UK, initiated a quality asthma audit of people with asthma to identify some of the risk factors identified in the NRAD report with the aim of optimizing patient care. Fifty (89%) of the General Practices caring for 415,152 patients (27,587 diagnosed with asthma (prevalence 7%; range 4–12%)), participated and the results identified a wide variation in process of care and presence of risk factors including: excess short acting reliever and insufficient preventer prescriptions, failure to issue personal asthma action plans, and to perform annual reviews or check inhaler technique. Identification of these patients involved high-intensity input by trained asthma nurses using sophisticated data extraction software. GP computer systems used in primary care currently do not have the functionally, without the need for manual audit, to implement the NRAD recommendations, starting with the identification of patients at risk. Modifications to existing systems within both primary and secondary care are required in order to prevent unnecessary deaths related to asthma. There is a pressing need to move towards a more pro-active model of care.

Highlights

In 2014 the Royal College of Physicians in London produced a report Why asthma still kills following the National Review of Asthma Deaths (NRAD)[1]This report was the result of a confidential enquiry into the deaths of 276 people in the United Kingdom (UK) which both highlighted some worrying failures of the care of those people with confirmed asthma death (195) and confirmed previous publication findings that most asthma deaths are associated with major preventable factors
This report was the result of a confidential enquiry into the deaths of 276 people in the UK which both highlighted some worrying failures of the care of those people with confirmed asthma death (195) and confirmed previous publication findings that most asthma deaths are associated with major preventable factors
The NRAD report included 19 recommendations that clinicians responsible for the care of people with asthma should observe in order to reduce the number of preventable asthma attacks, improve care, end any complacency regarding the management of this chronic disease, and highlight basic minimum standards that must be met

Summary

Introduction

In 2014 the Royal College of Physicians in London produced a report Why asthma still kills following the National Review of Asthma Deaths (NRAD)[1]This report was the result of a confidential enquiry into the deaths of 276 people in the UK which both highlighted some worrying failures of the care of those people with confirmed asthma death (195) and confirmed previous publication findings that most asthma deaths are associated with major preventable factors. A review of asthma care in 50 general practices in Bedfordshire ML Levy et al Fig. 1 Patients prescribed >12 Short Acting Beta-2 Bronchodilator (SABA) inhalers in previous year as % of total asthma population (range 1–14%, median 5.2%, (hashed line))

Results

Conclusion