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  5. 1. Identifying patients at risk of poor control

1. Identifying patients at risk of poor control

Identify patients with asthma who are at high risk of adverse clinical outcomes using risk factors from the National Review of Asthma Deaths (NRAD) report in 2014.

The accepted definition of SABA over-reliance is 3 prescriptions or more in 12 months (Global Initiative for Asthma). However, you may wish to focus on patients using 6 or more SABA in the first instance to focus on the highest priority patients. The National Bundle of Care for Children and Young People with Asthma recommends reviewing all children on 3 or more SABA inhalers per year.

Once patients have been identified, they can be invited for asthma reviews and provided with information about asthma care. Prioritising asthma reviews for these patients ensures that patients who need care the most are seen early, and ensures plenty of opportunity for follow up.

The process

Step 1: Search for patients with asthma who are at high risk of adverse clinical outcomes

Use the search to make a list of patients who have a diagnosis of asthma and:

  • have used fewer than 3 ICS in last 12m
  • OR have used 6 or more SABA in last 12m
  • OR have received 2 or more courses of oral steroids in last 12m
  • OR have had A&E attendance in last 12m
  • OR have had admission in last 12m
  • OR have code ‘asthma exacerbation’ in last 12m
  • OR have a DNA appointment in last 12m
  • OR do not have a personalised asthma care plan

Resource:

Step 2: Invite patients to Asthma Review Consultation

Invite identified patients for an asthma review with links to information on disease control.

You can prioritise patients from your search with the highest number of risk factors first by using our data collection table.

Resource:

Step 3: Conduct asthma review consultation with patient

You may use the downloadable PCIT Asthma Review Template and/or the guide on ‘Approach to asthma consultations’ to support this.

Resources:

Step 4: During consultation, consider whether specialist referral is needed

The majority of patients with poor control will improve with better adherence to preventers. However if they still have symptoms suggesting severe asthma, they may benefit from a referral to secondary care. Patients with severe asthma may be eligible for newer therapies such as biologics.

Resources:

Step 5: Follow up patients who do not respond to invite

Send list of identified patients to asthma nurse/ asthma lead/ reception/admin to chase up reviews, or set scheduled task for [x] months’ time to re-invite if not yet attended.

Step 6: Re-audit

Run search again in 6 or 12 months (see step 1)

Note that downloadable EMIS and SystmOne searches based on the NRAD risk factors are also available from the PrescQIPP website.

Resources

SMS templates

Invitation for patients with SABA over-reliance

SMS
It looks like you have needed 6 or more blue inhalers in the past year – this may mean that your asthma treatment needs improving. Please book an asthma review.

AccuRx SMS
It looks like you have needed 6 or more reliever (blue) inhalers in the past year – this may mean that your asthma treatment needs reviewing. Please book an asthma review.
To learn more read this leaflet https://bit.ly/3EmhyRT or watch this video https://bit.ly/3Vaqfoh.

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Consultation invite for high-risk patients

SMS 1 of 3
From your notes it looks like your asthma may not be well controlled. Please book an asthma review so we can review your treatment and reduce your symptoms.

SMS 2 of 3
An asthma review can reduce your risk of an asthma attack. To get the most out of your review see: https://www.asthma.org.uk/advice/manage-your-asthma/adult-review/

SMS 3 of 3
Remember to bring these things to your asthma review: your inhalers and spacer, your Personalised Asthma Action Plan and your peak flow meter.

Optional additional SMS
To learn more about asthma and your inhalers have a look here https://www.greenerpractice.co.uk/wp-admin/upload.php?item=1558

AccuRx SMS 1 of 2
From your notes it looks like your asthma may not be well controlled. Please book an asthma review so we can review your treatment, reduce your symptoms and reduce your risk of asthma attacks.
To get the most out of your review see:
https://www.asthma.org.uk/advice/manage-your-asthma/adult-review/
To learn more read this leaflet https://bit.ly/3EmhyRT or watch this video https://bit.ly/3EmhyRT.

AccuRx SMS 2 of 2
Remember to bring these things to your asthma review: your inhalers and spacer, your Personalised Asthma Action Plan and your peak flow meter.

Letter templates

Consultation invite for patients at risk of poor control

Dear Patient,

Our records show that your asthma may not be well controlled. This may be because you have had an asthma attack or exacerbation recently, or because you are needing more or less than the recommended amount of medication. Please call to book an asthma review appointment as soon as possible.

Asthma reviews are essential to help ensure you’re on the right treatment. Being on the right treatment should reduce your symptoms and lower your risk of future asthma attack. Many people don’t realise their asthma could be better controlled. Did you know that good asthma control means you will rarely or never have symptoms? Or that if you need three or more reliever (blue) inhalers a year, this could mean your asthma control needs improvement? To learn more read this leaflet https://bit.ly/3EmhyRT or watch this video https://bit.ly/3Vaqfoh.

This website explains how to get the most out of your review:

https://www.asthma.org.uk/advice/manage-your-asthma/adult-review/

We look forward to seeing you soon for your asthma review. Please remember to bring these things to your appointment: your inhalers and spacer, your Personalised Asthma Action Plan and your peak flow meter.

Many thanks,

[Practice name/ lead clinician]