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Observational Study
. 2024 Jan 8;14(1):e078947.
doi: 10.1136/bmjopen-2023-078947.

MISSION ABC: transforming respiratory care through one-stop multidisciplinary clinics - an observational study

Emily Heiden  1 , Jayne Longstaff  1 , Milan J A Chauhan  2 , Ruth DeVos  1 , Ellie Lanning  1 , Daniel Neville  1 , Thomas Llewelyn Jones  1 , Selina Begum  2 , Mark Amos  3 , Mark Mottershaw  1 , Joanne Micklam  4 , Ben Holdsworth  5 , Hitasha Rupani  1 , Thomas Brown  1   3 , Anoop J Chauhan  6   3 ; Mission ABC Collaborators
Collaborators, Affiliations
Observational Study

MISSION ABC: transforming respiratory care through one-stop multidisciplinary clinics - an observational study

Emily Heiden et al. BMJ Open. .

Abstract

Objectives: The Modern Innovative Solutions to Improve Outcomes in Asthma, Breathlessness and Chronic Obstructive Pulmonary Disease (COPD) (MABC) service aimed to enhance disease management for chronic respiratory conditions through specialist multidisciplinary clinics, predominantly in the community. This study assesses the outcomes of these clinics.

Design: This study used a prospective, longitudinal, participatory action research approach.

Setting: The study was conducted in primary care practices across Hampshire, UK.

Participants: Adults aged 16 years and above with poorly controlled asthma or COPD, as well as those with undifferentiated breathlessness not under specialist care, were included.

Interventions: Participants received care through the multidisciplinary, specialist-led MABC clinics.

Primary and secondary outcome measures: Primary outcomes included disease activity, quality of life and healthcare utilisation. Secondary outcomes encompassed clinic attendance, diagnostic changes, patient activation, participant and healthcare professional experiences and cost-effectiveness.

Results: A total of 441 participants from 11 general practitioner practices were recruited. Ninety-six per cent of participants would recommend MABC clinics. MABC assessments led to diagnosis changes for 64 (17%) participants with asthma and COPD and treatment adjustments for 252 participants (57%). Exacerbations decreased significantly from 236 to 30 after attending the clinics (p<0.005), with a mean reduction of 0.53 exacerbation events per participant. Reductions were also seen in unscheduled and out-of-hours primary care attendance, emergency department visits and hospital admissions (all p<0.005). Cost savings from reduced exacerbations and healthcare utilisation offset increased medication costs and clinic expenses.

Conclusions: Specialist-supported multidisciplinary teams in MABC clinics improved diagnosis accuracy and adherence to guidelines. High patient satisfaction, disease control improvements and reduced exacerbations resulted in decreased unscheduled healthcare use and cost savings.

Trial registration number: NCT03096509.

Keywords: Asthma; Patient Participation; Primary Health Care; Pulmonary Disease, Chronic Obstructive.

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Conflict of interest statement

Competing interests: All authors report no conflicts of interest. EL reports personal fees from Chiesi and Clement Clarke, not associated with this submitted work. TLJ reports non-financial support from Chiesi Farmaceutici outside of the submitted work. HR reports honoraria and lecture fees from Astra Zeneca, Teva, Novartis, GlaxoSmithKline and Chiesi, all of which are outside of the submitted work. TB reports personal fees from Astra Zeneca, grants, personal fees and non-financial support from GlaxoSmithKline, personal fees and non-financial support from Teva, non-financial support from Napp Pharmaceuticals and personal fees and non-financial support from Novartis, outside of the submitted work. AJC reports honoraria and lecture fees from Teva, Astra Zeneca and Sanofi and research grants from Airsonett, Novartis and GlaxoSmithKline, all of which are outside of the submitted work.

Figures

Figure 1
Figure 1
Patient identification, suitability and recruitment into the MABC study. COPD, chronic obstructive pulmonary disease; GP, general practitioner; MABC, Modern Innovative Solutions to Improve Outcomes in Asthma, Breathlessness and COPD.
See this image and copyright information in PMC

References

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