Did you know that the Department of Health has recently held three national asthma events jointly with Asthma UK in Birmingham, London and Bolton? These areas were chosen as they have higher than national average asthma admissions and large variations in asthma management.
The day, chaired by Professor Martyn Partridge, began by him inviting us to consider if we believe asthma to be 'sorted' and, if not, why not? There was an overwhelming response of 'no', which was supported by much research suggesting that morbidity and mortality continue at an unacceptably high rate, despite clear, national evidence-based guidelines.
After presentations from Dr Robert Winter, Joint National Director for Respiratory Disease at the DH, we divided into workshops. For me, the most interesting discussed the reasons why patients present to the Emergency Department (ED).
A fascinating insight was given into the age ranges of those most likely to be admitted – 0-4-year-old boys and middle-aged ladies appear to have the highest admission rates. Although we are aware that boys are more likely to develop asthma during childhood, while females are more likely to develop it during the teenage years, the current high rate isn't accounted for in total by this. In middle-aged ladies this could be related, in part at least, to a hormonal influence with the menopause. Does this reflect your experience of asthma admissions?
It was unanimously agreed at all three meetings that healthcare professionals' lack of disease-specific knowledge and skills to manage asthma, either acutely or as a long-term condition, was certain to influence admission rates. Other contributory factors included examples of healthcare professionals not working to evidence-based guidelines, offering nebulised therapy routinely in the ED to deliver high-dose bronchodilators (which may encourage patients to see the ED as a 'superior service' and so attend there), failing to offer patients personalised asthma action plans (which increases their risk four-fold of being readmitted to hospital) and failing to communicate effectively between care providers means review following an ED attendance may not occur.
Do any of these suggestions ring true with your area of practice? How good is the communication received from your local out-of-hours (OOH) providers, including A&E? Do you know what treatment is offered by these OOH providers? Is the care evidence based, ie, unless the attack is life threatening, are patients treated routinely with MDI/spacer rather than with a nebuliser? Where is the information about an ED attendance stored in primary care? Is it entered directly into patients' notes by admin staff, for example? Who is responsible for seeking out and acting on this information to ensure patients are followed up within 48 hours and subsequently receive self-management advice?
I urge you to find out – particularly at a time when we are trying to manage patients more effectively in primary care to reduce costs. What are the skills and competencies of those caring for your patients? How have their training needs been addressed? Look at the services offered in your area and see how communication links together and if there are gaps where patients can fall through the net.
Of interest to all healthcare professionals will be a brand new, free online resource called Inspiring Asthma Management – designed to help understand the stepwise approach to managing asthma. Visit www.inspiringasthmamanagement.co.uk
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