Expediting specialist review of patients with uncontrolled asthma in primary care via virtual multidisciplinary meeting and digital patient identification tool (ID 511)
Imperial College Healthcare NHS Trust, North Southall PCN, Imperial College Health Partners
Funding: The study was a joint working agreement between Imperial College Healthcare NHS Trust and AstraZeneca Plc.
Abstract
BackgroundUp to 200,000 people in the UK have severe or uncontrolled asthma, with significant impact on quality of life and healthcare cost. Biologic therapy may improve symptoms and reduce exacerbation frequency but access to treatment is variable with 60% of patients with uncontrolled asthma taking over 2 years to reach specialist care. We aim to improve identification of uncontrolled asthma in primary care and expedite specialist referral via a virtual multidisciplinary team meeting (MDT) coupled with an educational programme at a primary care network (PCN) in North West London (NWL).
Method
A secondary care asthma physician led a weekly virtual MDT. Attendees included GPs, nurses and pharmacists. Cases identified by PCN team were discussed as per MDT design (figure 1). To enhance case discussion, PCN pharmacists used a digital patient identification tool, SPECTRA(1), to identify high risk patients. Outcome measures included the number of patients referred to specialist care (and subsequent biologic therapy commencement), oral corticosteroid (OCS) and salbutamol prescription rates.
Results
There were 4068 adult asthmatic patients at the PCN. 24 MDTs were conducted between November 2022 and May 2023. Only 7 patients were presented. Two patients were referred to specialist centre with one biologic commencement (March 2024). SPECTRA search identified 60 high risk patients (figure 2). Four patients were highlighted for specialist referral with one patient commenced on biologic (March 2024). There was a significant reduction in salbutamol prescription (p = 0.01) though similar observation was made across NWL (table 1). There was no significant difference in OCS prescription (p = 0.40).
Conclusions
Virtual MDT coupled with patient identification tool such as SPECTRA can expedite identification of patients with uncontrolled asthma. However, commitment from primary care team remains vital. PCN pharmacists can provide the pivotal link between primary and specialist care.
Reference
1. SPECTRA website https://suspected-severe-asthma.co.uk/
Conflicts of interest: Dr Ernie Wong has received honorarium for consultation and delivery of educational sessions from AstraZeneca Plc (unrelated to above study); honorarium for delivery of educational sessions from Chiesi Limited; travel grant for conference attendance from GSK Plc.
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