Introduction:
Approximately 5.4 million people currently receive asthma treatment with an estimated 200,000 people having severe asthma (Asthma UK 2018). Despite taking maximal conventional medication this patient group remain symptomatic. This has a significant impact and burden to the health economy.
Aims & objectives:
We implemented an enhanced severe asthma pathway in November 2021, aiming to optimise primary care referrals through education and increase hospital and multidisciplinary team (MDT) clinic capacity. We evaluated the effectiveness of the enhanced pathway
Methods:
We targeted GP practices in Stoke-on-Trent and Staffordshire ICB with high SABA use and 2 or more courses of oral steroids in the last 12 months. The nurse educator ran the SPECTRA tool to identify poorly controlled asthma and delivered bespoke virtual, face to face educational sessions and offered 1:1 support.
Results:
By November 2022, 564 patients across 28 GP practices had been reviewed for asthma biologics eligibility, of whom 125 were referred to secondary care (22.2%). Eighty-seven of these patients started biologics (69.6%).
| Criteria | Reduction |
| Mean wait from referral to 1st appointment | 59% 10.7 vs 21.1 weeks p=0.002 |
| Time from 1st appointment to f/up | 45% 13.3 vs 24.4 weeks p<0.001 |
| Time from follow up to MDT discussion | 63% 6.7 vs 17.9 weeks p=0.004 |
| OCS use | 60% p<0.001 |
| SABA prescribing | P=0.037 |
| Exacerbations and hospital admissions | P<0.001 |
| ACQ 6 score | 3.13 to 1.89 |
Conclusion:
The enhanced pathway was associated with an increased number of patients on biologics with substantial reductions in patient waiting times, significant reductions in SABA and OCS prescribing rates, hospital admissions and improvements in asthma control.