M Corry 1, M O’Neill2, C Haughey 1
1Federation of Family Practices North Belfast Federation CIC, N. Ireland
2Screen Clinical Ltd, Tobermore Road, Draperstown, N. Ireland
Introduction
- GP pharmacists based in the North Belfast Federation wished to address the findings of the National Review of Asthma Deaths (NRAD) report and implement best practice to reduce the risk of serious events occurring in asthma patients
- With the NRAD report highlighting once again the issue of asthma deaths it was imperative that the practices took measures to address the findings and recommendations made in the report
- Screen clinical supported GP practices in North Belfast with identification and management of high risk patients. This service was funded by Napp Pharmaceuticals Ltd as a service to medicine
Aims
- To identify markers of poor control
- Improve the management of asthma
- Provide a baseline assessment of asthma management in the practices and highlight improvements
- Pharmacists to review the patients most at risk at asthma clinics
- Manage workload by stratifying the patients most at risk and in need of urgent review
- Improve patient safety and outcomes
Methods
The practice clinical systems were interrogated to identify the following patient cohorts:
- Asthma patients who had ordered 12 or more reliever inhalers (SABA) in the previous 12 months
- Patients who where the was evidence of under-prescribing/sub-optimal use of preventer medication (ICS)
- Patients who were prescribed separate ICS and LABA inhalers
- Patient with no annual asthma review (AAR) in the preceding 12 months
- Patients with a hospital admission or 2+ oral steroids (OS) in the last 12 months
- Patients who were prescribed regular inhalers and who were not on the practice’s respiratory registers
Interventions
- Validation of practice respiratory registers (asthma and COPD) to improve accuracy and practice governance. Ensured all patients prescribed regular respiratory medication had an accurate diagnosis recorded.
- Invitation to asthma review with Screen Clinical Pharmacist for high risk / uncontrolled patients
- Medications use review including compliance check – using clinical notes and face-to-face during asthma review
- Patient education focussing in disease, symptom recognition and management of potential exacerbations
- Inhaler technique check
- Peak Expiratory Flow Rate (PEFR) performed
- FeNO testing (where appropriate and in line with guidelines)
- Self management plan
- Medicinal intervention (where appropriate and in line with guidelines)
Conclusions
- 77% of patients using ≤3 SABA inhalers
- 87% of patients were receiving their AAR in line with QoF targets
- There was a correlation between no annual asthma review and under use of ICS
- Practices have reported improvements in the way they manage their asthma reviews following this project
- Staff report greater awareness of the significance of overuse of SABAs and inappropriate use of ICS
- Patients report improved knowledge of their use of their inhalers
