Abstract

Introduction:
Biologics are potentially “life-changing” therapies for appropriate severe asthma patients. In this project, we aimed to improve access to biologics across Humber and North Yorkshire Integrated Care System (HNY-ICS).
Methods:
1. Participating GP Practices within the HNY-ICS had a remote search run on their system to identify patients with asthma who were receiving ICS/LABA combination therapy and who had been prescribed either 3 or more courses of prednisolone in the past 12 months or maintenance prednisolone
2. Patients identified from the search were invited for up to 3 virtual reviews by a Respiratory Specialist Nurse. Review were supported by use of a detailed clinical assessment template and referral criteria, developed in collaboration with the severe asthma service.
3. Patients whose asthma remained uncontrolled after virtual reviews were referred to the severe asthma service for ongoing management and biologic initiation if appropriate; the rest remained under the care of their GP Practice.
Results:
From 35 participating practices (276,876 total practice population and 17,396 asthma patients), 435 patients (2.5% of asthma population) were invited for a review after initial case note evaluation. 331 attended the first review, 203 a second and 74 a third. 464 (76%) of total reviews were completed with a new or updated written personalised asthma action plan. 38 (11.5%) patients were referred to the severe asthma service.
Conclusion:
All patients identified met criteria for a trial of treatment with biological therapies; however, standard asthma care and treatment optimisation led to improved asthma control in most. Less than 0.5% of the whole asthma population were referred to the severe asthma service. This suggests that the vast majority of asthma patients who otherwise meet criteria for biological therapies can be managed in primary care with appropriate review and treatment optimisation, potentially improving patient outcomes whilst optimising NHS resource use.