On this page
The benefits of this project
Benefits for Your Patients
- Reduces risks related to undertreatment such as asthma attacks
- Reduces risks from unnecessary treatment
Benefits for Your Practice
- Understanding how an asthma diagnosis is made for patients at your practice will help you to identify areas for improvement.
- Reduced workload from improved asthma care for those diagnosed as asthma and reduced prescription requests from those who do not have asthma.
Benefits for The Planet
- Reduces unnecessary prescriptions of SABA inhalers
Opportunity for improvement
- 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.
- Coding suspected asthma is important so that patients can be followed up appropriately. The SNOMED code is: 394967008 Suspected asthma (situation).
- The search for this project is limited to patients aged 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.
- You might like to make a SMART goal for this project, e.g. within 6 months, train 100% of nurses and clinicians on asthma diagnosis coding and follow-up protocols with a 30-minute workshop.
How to carry out this project
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Find out how asthma diagnoses are made in your practice.
Discuss with colleagues and review local guidance. Identify: - what they do if treatment is needed at first presentation
- which diagnostic tests are available
- which codes are used (suspected asthma/asthma)
- the follow-up process, both within primary care and after hospital assessment or admission
Engage the whole team in this process, particularly practice nurses and clinicians who frequently do asthma reviews. Discuss whether there are barriers to diagnosis.
Coding ‘suspected asthma’ is important so that patients can be followed up appropriately. If inadequate follow-up occurs, patients may keep the suspected asthma code. It is important to resolve these codes to ensure that patients receive appropriate asthma treatment and follow-up, or an alternative diagnosis.
Consider whether changes or improvements are needed. Is there a respiratory lead? If not, could you become one?
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Search for patients aged 5 and over who have been prescribed SABA in the last 12 months AND do not have a diagnosis of asthma AND do not have a diagnosis of COPD.
Check if any asthma diagnostic tests have been done for these patients.
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Review the patient notes.
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.
Resource: Data Collection Table
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Update the coding.
Where the correct diagnosis has been made but not coded correctly, update the coding. -
Organise a team education/clinical update session.
Ensure everyone involved in asthma care at your practice is invited. Consider doing this at PCN level for increased coverage. Present the data obtained from steps 1-3 Obtain feedback from the team regarding the current diagnostic process and available tests. Would it be helpful to write a practice or PCN level pathway for diagnosis that is adjusted to the diagnostic tests available?
Resources:
Objective test algorithm for people aged 16+
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Invite all patients with an unclear diagnosis for a review.
Use the data collection table to stratify the risk and prioritise those presenting with one or more exacerbations in the last year. Give patients a timeframe to respond (e.g. 6 weeks). Check for non-responders following this time period and repeat contact. Consider alternative method (such as letter or phone call).
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SMS Template
Resource: Consultation invitation for patients on SABA-only therapy without diagnosis
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.
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Letter Template
Resource: 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]
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After conducting your team education session and clinical reviews repeat the search in step 2 to assess change.
Top tip
What I have done: this whole page was copy/pasted from the iron prescribing page so I've gone through and changed everything to what I think it should be but you might want to double check it (especially the letter/SMS section)
What still needs doing: top-tips
How to scale this project up or down
| Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members. |
You could upscale this project by taking it to your PCN pharmacy team to implement across all practices in your PCN. You could go wider and suggest the ICB medicines optimisation team includes it in a Pharmacy Quality Scheme.
Have you completed this QIP?
Tell us a little about your project and enter your data in order to generate a certificate showing the cost and carbon savings and other probable benefits. This project may help with CQC evidence submission (see disclaimers).
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