Plenary - Neil Churchill (Asthma UK) - A call to action Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013, Guoman Tower Hotel, London How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

1. A Call to Action
Neil Churchill
21 February 2013
Context
• UK admission rate for asthma is almost 40% above
OECD average;
• Asthma one of top five causes of child emergency admissions;
• Mortality rate three times as high as Netherlands;
• Surveys suggest 45% of asthma population have sub-optimal
control, yet 55% may be over-treated with combination
therapies;
• Annual cost of asthma to NHS £1bn+
o £990 on prescribing
o £120m on GP consultations
o £61m on emergency admissions
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2. A platform for improvement
• Respiratory disease in the Outcomes Framework
• New quality standards for asthma published today
• National Clinical Director
• Local priorities established but no networks
• A National Review of Asthma Deaths
• Efforts being made to continue the improvement
programme.
What have we learned from the asthma
improvement projects so far?
• Wide variation in compliance with clinical standards
• Some starting from very low base
• Incentives work – LES; CQUIN
• Other routes to engagement work too – education; peer
encouragement
• Certain interventions are effective where applied
within supportive system
•Those interventions improve outcomes and increase
productivity
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3. How will quality standards help?
• Inclusion of personal asthma action plans
• Inclusion of inhaler technique
• Oral steroids within one hour of acute attack
• Review before discharge
• Rapid follow-up by GP
• Multi-disciplinary assessment for difficult asthma
How will quality standards help?
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4. What more do we need to learn?
• Longer term health improvement and cost benefit of
interventions
• Patient engagement in their treatment – commitment
not compliance
• Diagnosis and management in older cohorts
• Effective risk stratification and management
• Integrated care across organisational boundaries
• Optimal organisation of severe asthma care
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5. Improving Patient Engagement – Asthma UK
• Triple A Test – Avoid Asthma Attacks;
• Testing risk versus control as means of patient
engagement;
• Drawn on published research evidence of risks;
o 52,600 participants for £6k spend;
o 36% at highly increased risk of attack;
o Follow-up studies suggest 36% were avoiding
triggers; 42% taking medicines more regularly; 22%
discussed finding with doctor or nurse;
o 85% would recommend test to others.
Where next? Adapt tool for general practice?
National Review of Asthma Deaths
Targeting risk factors
Anagnostou A, Harrison B, Iles R, Nasser S, PCRJ 2012;21(1);71-77
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