Leads:
University Hospitals North Midlands: Dr Elfatih Idris
University of Birmingham: Dr Sarah Damery
Dates:
1 March 2022 – 31 December 2022
Background:
Uncontrolled severe asthma can reduce patient quality of life and increase the need to use oral corticosteroids (OCS) and ‘rescue and reliever’ medications known as short-acting beta agonists (SABA) to manage symptoms.
Asthma biologics are specialist treatments that act on specific cells in the body to stop the processes that cause lung inflammation. Biologics are given for severe asthma at a specialist asthma clinic, or patients can learn to treat themselves at home. However, treatments are only available to patients that meet strict criteria, and patients must be assessed at specialist hospital asthma clinics by a multidisciplinary team (MDT) before they can start treatment. Specialist clinics have limited capacity, meaning that many patients with severe asthma wait a long time to be approved for treatment.
Policy and Practice Partners:
University Hospitals North Midlands NHS Trust
University of Birmingham
Co-Funding partners:
NHS Accelerated Access Collaboration
ARC West Midlands
Aims and Objectives:
To assess the effectiveness of the changes to the severe asthma pathway within UHNM by:
- Describing the implementation of the new severe asthma pathway across the UHNM catchment area and to understand key stakeholders experiences of the new pathway.
- Analysing routinely collected data to explore changes in key metrics over time.
- To identify strengths and limitations of the new severe asthma pathway, any areas for further development and to make recommendations to inform future service design and commissioning.
Methods:
WP1 involved undertaking semi-structured interviews (n=12) with key people from the relevant stakeholder organisations involved in delivering and commissioning care for patients with severe asthma. This included clinical and operational staff involved in the organisation, delivery and commissioning of severe asthma services across primary, secondary and tertiary care. Interview participants were purposively sampled to ensure a range of roles was covered.
WP2 involved quantitative analysis of the change over time in key metrics relating to the management of severe asthma. This used routinely collected, aggregated and anonymised data from primary, secondary and tertiary care, collated by the clinical team at UHNM. Analysis focused on trends in biologics use over time (including patient wait times for treatment/appointments at all stages of the severe asthma pathway); healthcare use (A&E attendances and hospital admissions); referrals and process data; asthma control (using the Asthma Control Questionnaire), and changes to prescribing of rescue and reliever medications.
The final work package brought together the data from WP1 and WP2 to develop recommendations about how patient pathways for the management of severe asthma should be organised and delivered in the future.
Main Results:
The qualitative work demonstrated that practitioners in primary care, secondary care and tertiary care were able to work more efficiently together under the new pathway, with streamlined communications and faster assessment of patients. Nearly all quantitative metrics demonstrated significant improvements (results currently being written up for publication).
Conclusions:
Increasing capacity at a secondary care severe asthma clinic and providing training on appropriate diagnosis and referral in primary care was highly effective in improving patient waiting times for referral, diagnostic confirmation and initiation on effective biologics treatments. More appropriate referrals from primary care were made, and substantial reductions were observed in short-acting beta-agonist (SABA) and steroid prescribing and in A&E and hospital attendances for asthma exacerbations.
Implications for Implementation:
The evaluation findings provide key information to stakeholders providing services within primary, secondary and tertiary care, and to specialised commissioners around referral volumes, and the barriers and facilitators of effective cross system management of patients with severe asthma. As a results of the changes made, the severe asthma clinic has been formalised into routine working beyond the lifetime of the initial funding. Engagement with primary care has continued, and the number of patients treated using biologics continues to increase, as does the proportion self-administering treatments at home via the newly established homecare service. This has positive implications for the potential longer-term sustainability of changes to service organisation and the upscaling of implementation beyond this project.
Protocol:
N/A
Publication:
Awaited.