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The UK's primary care sustainability network

2. Patients on short acting beta agonist (SABA) therapy only without a diagnosis

Patients who present with possible symptoms of asthma may have been commenced on a SABA inhaler and if follow-up did not occur, these patients are at risk of undertreatment, especially if a suspected diagnosis is not coded. This project enables you to identify all patients receiving a SABA who do not have a diagnosis, so that diagnosis and management can be reviewed and optimised.

The search for this project is limited to patients age 5 and over, to minimise the number of patients who have received SABA inhalers for viral wheeze where it may be too early for an asthma diagnosis to be considered. Your search may reveal patients who are likely to have other diagnoses, which will need confirmation and coding.

The process

Step 1: Search for patients on SABA only therapy without a diagnosis

Use the search to create a list of patients aged 5 and over who have been prescribed a SABA in the 12m
AND do not have a diagnosis of asthma
AND do not have a diagnosis of COPD

Resource:

Step 2: Review the notes

Review the patient notes to find out:

  • Which diagnosis was suspected?
  • Have they received follow-up from the initial appointment where SABA was prescribed?
  • Has the diagnosis been made but not coded?
  • Have they had any exacerbations that suggest they may need urgent review?

Use our data collection table to record this information and your subsequent action.

Resources:

  • Data collection table for Diagnosis Project 2.
  • Primary care IT resource to pull out information on number of issues and dates and other respiratory diagnosis: Report called GIP01) Project 2 Step 2 On SABA without a diagnosis
Step 3: Update the coding

Where the diagnosis has been made but not coded correctly, update the patient record by coding the diagnosis.

Resource:

Step 4: Invite patients to consultations if review needed

Send information and invitation for a consultation to patients where any of following apply:

  • diagnosis not clear
  • experiencing exacerbations or multiple presentations with symptoms
  • Using 3 or more SABA a year

Remember to consider your process for follow up of patients who do not respond to this invitation.

Resource:

  • SMS/Letter invitation (see at bottom of page in resources)
Alternative step 4: Set visibility alert for patients if review needed

Instead of inviting patients to make an appointment, set a visibility alert on the patient record to highlight at their next contact that therapy and diagnosis need reviewing.

Resource:

Primary Care IT resource: Protocol in EMIS, patient status alert in System One called GIP01) Project 2 Step 4 On SABA not on COPD or Asthma register

Re-audit

Run the search in Step 1 regularly to make sure you are making progress with identifying patients who are receiving SABA without a diagnosis.

Resources

SMS templates

Consultation invitation for patients on SABA-only therapy without diagnosis

SMS
Your doctor or nurse needs to review your inhaler medication to check you are on the best treatment for your symptoms. Please make a routine appointment.

Letter templates

Consultation invitation for patients on SABA-only therapy without diagnosis

Dear Patient,

We would like to invite you to make an appointment to discuss your inhaler medication. These medications are usually given for symptoms like cough, wheezing or difficulty in breathing. These symptoms can be due to short-term problems like chest infections, but they may also be due to long-term conditions like asthma and COPD (chronic obstructive pulmonary disease)

Your doctor or nurse needs to  check if you are still having symptoms and discuss whether you need any further investigations to check for long-term conditions such as asthma or COPD. This will help us to ensure you receive the best possible treatment.

Please contact us to make a routine appointment,

Many thanks,

[Practice name/ lead clinician]