Introduction There were 79,794 emergency hospital admissions for asthma in the UK in 2008–09 - an estimated 75% were avoidable . Asthma admissions from Bristol GP practises contributed to this; over 600 people were admitted to hospital in this year because of their asthma. NHS Bristol set out to improve asthma management and reduce asthma hospital admissions across the Primary Care Trust
Method Previous audits identified variations in asthma management across Bristol GP practises. Initial data searches identified some practises provided annual asthma reviews to 73.3% of their asthma register, others only 36.4%. Inhaler technique was checked in 60.8% of patients in some practises, in others only 16.9%. NHS Bristol commissioned NSHI Ltd* to run the IMPACT* service across Bristol GP practises to reduce these variations.
The IMPACT service provided a therapeutic review, modular education and detailed clinical review by diploma trained asthma nurses, according to agreed practise protocols. Asthmatic patients were invited to attend a structured clinical review of their asthma. Patients were given a self-management plan and educated in better managing their condition. Practise staff were also provided with enhanced respiratory training.
Results There has been a 19.5% reduction in asthma admissions in the period from February 2011–January 2012 in Bristol (n=37) compared to the previous year. There were 90 admissions in IMPACT practises (n = 13) and 303 admissions in non-IMPACT practises (n=43) during this period. The IMPACT practises have observed a reduction of 35.6%, and the non-IMPACT practises have observed a reduction of 12.4%. Overall, 13 IMPACT practises accounted for 54.7% of the reduction.
Conclusion A structured approach to asthma management (including the provision of education to health care professionals in line with national asthma guidelines) and increasing patient awareness of asthma (including knowledge of how to manage their symptoms) can reduce variations in asthma care and hospital admissions.
Asthma UK for Journalists: Key facts and stats: www.asthma. uk.org (Viewed July 2012).
*NSHI Ltd (National Services for Health Improvement).
*Improving the Management of Patients Asthma and COPD Treatment. (IMPACT) is an independent nurse service sponsored by TEVA UK Limited.