Severe Asthma Care Reimagined: Bridging Gaps for Equitable Access from Primary to Specialist Care (ID 556)
University of Oxford
Abstract
Introduction
The Integrated Severe Asthma Care (ISAC) initiative aimed to enhance severe asthma care within populations experiencing high health inequalities across the Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care System. Conducted between November 2021 and March 2024, this pharmacist-led, consultant-supported project focused on increasing access to asthma biologics, implementing FeNO testing, and educating primary care clinicians on severe asthma management.
Methods
ISAC provided outreach clinics in 47 general practices across 14 Primary Care Networks (PCNs), utilising digital tools to identify potentially uncontrolled asthmatics. Patients received comprehensive reviews, bespoke education, treatment optimisation, and fast-tracked referrals to the severe asthma centre. Newly established virtual multidisciplinary team (MDT) meetings facilitated collaborative patient assessments. The ISAC team also delivered bespoke asthma training to primary care clinicians.
Results
Pharmacists analysed 2,318 patient records and reviewed 214 patients face-to-face. Among these, 43% had their medications optimised in primary care, with significant reductions in short-acting beta-agonist inhaler use and switches to dry powder inhalers. Over 500 additional tertiary care severe asthma clinic appointments were delivered within the system, and regional MDTs facilitated a 4-month acceleration in patient access to biologics.
As a result, 141 new patients commenced asthma biologics, with an estimated saving of £1,183,946 over five years through reduced acute healthcare usage. Additional savings from reduced oral steroid courses range from £25,211 to £1,852,007 annually.
Patient feedback was overwhelmingly positive, with 98% finding the service very good and 65% reporting improvement in their asthma following ISAC reviews.
Conclusions
The ISAC project significantly improved operational efficiency, clinical outcomes, and patient satisfaction in severe asthma management. It demonstrated a replicable model for integrating highly advanced pharmacists across healthcare setting and addressing health inequalities. The project's approach to patient-centred care, innovative diagnostic tools, and collaborative healthcare delivery sets a new standard for asthma management within the system and beyond.
Funding: The ISAC project was funded mainly by the NHS Accelerated Asthma Collaborative's Rapid Uptake Products Scheme and the Innovation for Health Inequalities Programme, supplemented by a small contribution from the industry in the early stages.
Conflicts of interest: None
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