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

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.

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))

Fig. 2

Percentage of patients in practices collecting insufficient (<75%) authorized inhaled corticosteroid (ICS) prescriptions (range 10–62%, median 32% (hashed line))

Fig. 3

Number of practices with evidence in the medical records of provision of PAAP as % of total asthma population in the practice (range 0.6–98% & median 26% (hashed line))

Fig. 4

Number with evidence of a record of an annual review as % of total asthma population in the practices (range 15.8–87.4% & median 68% (hashed line)

Fig. 5

Numbers of patients who had evidence that their inhaler technique was checked in the last year as % of total asthma population (range 7.5–83.1%, Median 49.6% (hashed line))

Fig. 6

Prevalence (%) of total practice population diagnosed (Read Coded) with asthma (range 4–12%, median (hashed line) 6.5%)