Hospital launches various interventions to reduce asthma-related admissions and improve the use of personalised asthma action plans, increasing the uptake and improving control

Synopsis:

Asthma still kills. The 2014 National Review of Asthma Deaths (NRAD) found there were significant avoidable factors contributing to these deaths, including failure to ensure simple interventions were delivered, and lack of education for health professionals and patients.

There have been five asthma deaths of young people in our region since NRAD was published, each case highlighting the same failings as outlined in the report. Following a number of stakeholder focus groups and the development of a regional partnership, the BReATHE (Beating Regional Asthma Through Health Education) interventions were developed:

1. An online resource www.beatasthma.co.uk

2. Regular education days

3. A local nurse led ‘one-stop-shop’ clinic, where key education messages were delivered

4. New pathways for emergency admissions: an asthma discharge bundle and follow-up phone calls following discharge

5. A local asthma service

6. Cascade training for school health teams

These resulted in:

• A sustained reduction in local paediatric emergency asthma admissions by 29 per cent equating to a net cost saving of £77,000 in three years

• Improved over-all asthma control The main stakeholders of patients, families and health professionals, from primary to tertiary care across the region, were involved at all stages of the project, from initial conception, to design and delivery.

Ambition:

Asthma still kills. 14 per cent of 195 asthma deaths in 2012 were young people. The 2014 National Review of Asthma Deaths (NRAD) found there were significant avoidable factors contributing to these deaths, including failure to ensure simple interventions were delivered, and lack of education for health professionals and patients.

There have been five asthma deaths of young people in our region since NRAD was published, each case highlighting the same failings as outlined in the report. Families reported feeling frustrated at the lack of available information. Young people reported feeling disempowered.

Ambition: To improve asthma outcomes in our region by improving education, establishing seamless links between services, supporting children and families to self-manage, and ultimately preventing avoidable deaths.

Targets:

1. Reduce asthma-related emergency hospital admissions

2. Improve the use of personalised asthma action plans (PAAPs)

3. Improve long-term asthma control: measured using the validated Asthma Control Test (ACT) score where a 2-point increase is recognised as a clinically significant improvement.

Planning: A regional paediatric partnership was developed including representatives from primary to tertiary care, raising awareness of key problem areas and developing workable solutions. Focus groups were held with main stakeholders: health-professionals, parents of children with asthma and young people with asthma.

Outcome:

These collaborations informed the multi-faceted approach – ‘BReATHE’ (Beating Regional Asthma Through Health Education):

1. An online resource www.beatasthma.co.uk aimed at the key user groups of health-professionals, families, young people and schools, providing standardised paperwork for the region, educational resources and tools.

2. Regular education days attended by over 110 health-professionals

3. A local nurse led ‘one-stop-shop’ clinic, taking referrals from primary and secondary care, offering one appointment where key education messages can be delivered

4. New pathways for emergency admissions: an asthma discharge bundle ensuring key recommendations were delivered and follow-up phone calls following discharge

5. A local asthma service, ensuring higher-risk patients were able to be reviewed by a specialist following discharge.

6. Cascade training for school health teams Results:

• Emergency admissions in Newcastle have reduced by 29 per cent and this has been sustained for the last three years. Including initial set up costs, this equates to a £77,000 cost saving

• Improved ACT scores by an average of 6 points

• PAAP uptake in primary care has increased from 5 per cent to 53 per cent and secondary care from 30 per cent to 80 per cent

• Asthma Discharge bundle dissemination after acute admissions has become integrated into routine practice locally and is occurring in 80 per cent of cases

Spread:

• BeatAsthma has had over 20,000 views world-wide since its launch in November 2017

• The shared paperwork has been adopted by every trust in the North East and North Cumbria, standardising care and patient experience across the region.

• The resource has the support of Dr Mark Levey, the author of NRAD, for national use and a number of trusts nationally have already adopted it.

• It has been promoted internationally and work is currently underway to translate and culturally adapt it for use in India.

• The educational materials have been adopted into routine practice by a number of primary and all secondary care providers in the region.

• The new BeatAsthma one day training day, using the educational materials from the online resource, will run next month and has sold out with a waiting list and attendees from across the country.

• The ‘BeatAsthma Schools Package’ has been disseminated to a number of schools in Newcastle and work is under way to develop the ‘BeatAsthma Friendly School label’ for fully compliant schools

Value:

There has been excellent feedback from all user groups with both staff and patients reporting feeling empowered and more able to manage children’s asthma. An emergency admission is a known risk factor for death from asthma and the single biggest risk factor for further asthma attack. The 29 per cent reduction in unplanned admissions is more significant given:

• In the three years prior to intervention, unplanned admissions locally were increasing each year by over 30 per cent

• The reduction has been sustained for the three years since the start of the interventions

• There has been a 10 per cent increase region wide over the same time period In addition to the financial benefit this reduction in hospital admissions incurs, the impact of improved asthma care and ultimately improved asthma control on the wellbeing of both families and young asthma sufferers will lead to fewer missed school days due to illness and the corresponding missed work days for parents.

The success of BReATHE is being used to model similar interventions in other regions, thus increasing cost savings further and improving experience further.

Involvement:

The problem was highlighted originally by patients, professionals, the NRAD report and the tragic deaths in our region. The main stakeholders of patients, families and health professionals, from primary to tertiary care across the region, were involved at all stages of the project, from initial conception, to design and delivery. Collaboration is ongoing with all stakeholders to maintain, update and further develop the interventions and by continuing to be involved in their development and promotion.

The development of a resource area for schools was entirely developed following feedback from the young people user group, who highlighted this as an area where they felt the most vulnerable. Being more in control of their own disease and feeling empowered to manage it was frequently highlighted as crucial in the focus groups and has remained a consistent theme in all that has been done.

This project received minimal financial support, but it was clear to all involved in children’s asthma care that there was an urgent need for change. BReATHE was delivered through the collaboration, passion and determination and of all those involved to make a real difference to the children in our region.