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Complacency in asthma care is costing lives, UK experts warn
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A comprehensive review of asthma deaths in the UK has shone a light on routine failures of basic care and prescribing errors of a “frankly horrifying scale”. The authors of the first confidential enquiry report, commissioned by the Healthcare Quality Improvement Partnership (HQIP) and managed by the Royal College of Physicians, are calling for an end to complacency around asthma care so that more is done to save lives. The UK already has among the highest rates of asthma mortality in Europe, with the latest findings showing that asthma deaths are on the rise again. The review—published to coincide with World Asthma Day on May 6—explored the circumstances surrounding 195 asthma deaths that occurred between February, 2012, and January, 2013. The standard of care received by patients with asthma was reported to be less than satisfactory in a quarter of those who died, and there was “room for improvement” in the care received by 83% of those who died. 45% of patients who died from asthma did not have any medical assistance during the final asthma attack—for 65 patients there was no record of them seeking medical assistance, and 22 tried to get help but died before medical treatment could be given. Additionally, 57% of patients were not recorded as being under specialist supervision during the 12 months before they died. The authors of the review uncovered some major issues with prescribing, with avoidable errors present in 47% of asthma deaths. Particularly, there was an excessive over-reliance on reliever inhalers and underuse of preventer inhalers. To address the situation, the authors call for electronic surveillance of prescribing in primary care to be introduced as “a matter of urgency”
to alert clinicians to patients being prescribed excessive quantities of short-acting reliever inhalers, or too few preventer inhalers, as well as a national audit to help clinicians, commissioners, and patient organisations to work together to improve asthma care. Kay Boycott, Chief Executive of Asthma UK (London, UK) described the findings of the review as a “damning indictment of current routine practice”. She added: “On the basis of this evidence regulators should redouble efforts to ensure prescribers are making appropriate use of medicines, and plans should be put in place to offer better selfmanagement support and risk assessment for everyone with asthma.” The review recommends that every NHS hospital and general practice should have a designated, named clinical lead for asthma services, responsible for formal training in the management of acute asthma, in view of the basic errors occurring in routine care. Chris Griffiths, from Queen Mary University of London (London, UK), said: ”Those of us who work in general practice must implement the recommendation to have a named clinician responsible for asthma in each practice. Despite facing huge challenges as we work to meet current NHS organisational change, we need to prioritise asthma care in order to reduce deaths in the UK.” Asthma is included in the Quality and Outcomes Framework (QOF) which incentivises high-quality care in UK practices, but the authors of the review noted failings in primary care in 70% of the deaths studied. In 43% of deaths there was no evidence of an asthma review in the previous 12 months. Of patients seen in primary care in the 12 months before death, only 24% had received a personalised asthma action plan.
“We have been asking for a number of years to include personal asthma action plans in the QOF”, said Emily Humphreys of Asthma UK. “We know that patients are four times more likely to end up in hospital if they do not have an action plan”, she warned. Stephen Gaduzo, from the Primary Care Respiratory Society (Birmingham, UK), agreed that improvements were needed within primary care. He said: “GP practices need to be supported and incentivised to improve the quality of routine asthma care so that lives can be saved. “Best practice in asthma management is set out clearly in the British Guideline on the Management of Asthma, the QOF, the asthma quality standard for England, and the respiratory strategies in Wales and Northern Ireland. But they need embedding into routine practice. We need to learn from this important piece of work, and put the learning into practice so that the number of asthma deaths comes down”, he added. Shuaib Nasser, from Cambridge University Hospitals (Cambridge, UK), described the asthma deaths reported by the enquiry as “a call to action”, not only for GPs but for all health professionals to better understand why asthma kills and to work together with patients. He said: “The report highlights the variability of asthma in every individual and this requires improved documentation of triggers and severity. “Patients want to understand their asthma better and to know the triggers for their asthma symptoms. If these are identified early, people with asthma will become much better at managing their condition and be able to predict when to increase their treatment or call for help”, he continued. “If the key recommendations are implemented asthma deaths will be substantially reduced.”
Ian Hooton/Science Photo Library
Complacency in asthma care is costing lives, UK experts warn
Lancet Respir Med 2014 Published Online May 6, 2014 http://dx.doi.org/10.1016/ S2213-2600(14)70091-8 For the full review see http:// www.hqip.org.uk/assets/ NCAPOP-Library/ NCAPOP-2014-15/NRAD-report6May20214.pdf
Sanjay Tanday
www.thelancet.com/respiratory Published online May 6, 2014 http://dx.doi.org/10.1016/S2213-2600(14)70091-8
1
A comprehensive review of asthma deaths in the UK has shone a light on routine failures of basic care and prescribing errors of a “frankly horrifying scale”. The authors of the first confidential enquiry report, commissioned by the Healthcare Quality Improvement Partnership (HQIP) and managed by the Royal College of Physicians, are calling for an end to complacency around asthma care so that more is done to save lives. The UK already has among the highest rates of asthma mortality in Europe, with the latest findings showing that asthma deaths are on the rise again. The review—published to coincide with World Asthma Day on May 6—explored the circumstances surrounding 195 asthma deaths that occurred between February, 2012, and January, 2013. The standard of care received by patients with asthma was reported to be less than satisfactory in a quarter of those who died, and there was “room for improvement” in the care received by 83% of those who died. 45% of patients who died from asthma did not have any medical assistance during the final asthma attack—for 65 patients there was no record of them seeking medical assistance, and 22 tried to get help but died before medical treatment could be given. Additionally, 57% of patients were not recorded as being under specialist supervision during the 12 months before they died. The authors of the review uncovered some major issues with prescribing, with avoidable errors present in 47% of asthma deaths. Particularly, there was an excessive over-reliance on reliever inhalers and underuse of preventer inhalers. To address the situation, the authors call for electronic surveillance of prescribing in primary care to be introduced as “a matter of urgency”
to alert clinicians to patients being prescribed excessive quantities of short-acting reliever inhalers, or too few preventer inhalers, as well as a national audit to help clinicians, commissioners, and patient organisations to work together to improve asthma care. Kay Boycott, Chief Executive of Asthma UK (London, UK) described the findings of the review as a “damning indictment of current routine practice”. She added: “On the basis of this evidence regulators should redouble efforts to ensure prescribers are making appropriate use of medicines, and plans should be put in place to offer better selfmanagement support and risk assessment for everyone with asthma.” The review recommends that every NHS hospital and general practice should have a designated, named clinical lead for asthma services, responsible for formal training in the management of acute asthma, in view of the basic errors occurring in routine care. Chris Griffiths, from Queen Mary University of London (London, UK), said: ”Those of us who work in general practice must implement the recommendation to have a named clinician responsible for asthma in each practice. Despite facing huge challenges as we work to meet current NHS organisational change, we need to prioritise asthma care in order to reduce deaths in the UK.” Asthma is included in the Quality and Outcomes Framework (QOF) which incentivises high-quality care in UK practices, but the authors of the review noted failings in primary care in 70% of the deaths studied. In 43% of deaths there was no evidence of an asthma review in the previous 12 months. Of patients seen in primary care in the 12 months before death, only 24% had received a personalised asthma action plan.
“We have been asking for a number of years to include personal asthma action plans in the QOF”, said Emily Humphreys of Asthma UK. “We know that patients are four times more likely to end up in hospital if they do not have an action plan”, she warned. Stephen Gaduzo, from the Primary Care Respiratory Society (Birmingham, UK), agreed that improvements were needed within primary care. He said: “GP practices need to be supported and incentivised to improve the quality of routine asthma care so that lives can be saved. “Best practice in asthma management is set out clearly in the British Guideline on the Management of Asthma, the QOF, the asthma quality standard for England, and the respiratory strategies in Wales and Northern Ireland. But they need embedding into routine practice. We need to learn from this important piece of work, and put the learning into practice so that the number of asthma deaths comes down”, he added. Shuaib Nasser, from Cambridge University Hospitals (Cambridge, UK), described the asthma deaths reported by the enquiry as “a call to action”, not only for GPs but for all health professionals to better understand why asthma kills and to work together with patients. He said: “The report highlights the variability of asthma in every individual and this requires improved documentation of triggers and severity. “Patients want to understand their asthma better and to know the triggers for their asthma symptoms. If these are identified early, people with asthma will become much better at managing their condition and be able to predict when to increase their treatment or call for help”, he continued. “If the key recommendations are implemented asthma deaths will be substantially reduced.”
Ian Hooton/Science Photo Library
Complacency in asthma care is costing lives, UK experts warn
Lancet Respir Med 2014 Published Online May 6, 2014 http://dx.doi.org/10.1016/ S2213-2600(14)70091-8 For the full review see http:// www.hqip.org.uk/assets/ NCAPOP-Library/ NCAPOP-2014-15/NRAD-report6May20214.pdf
Sanjay Tanday
www.thelancet.com/respiratory Published online May 6, 2014 http://dx.doi.org/10.1016/S2213-2600(14)70091-8
1