Introduction Asthma and COPD account for a significant proportion of inpatient admissions in the UK. A national review of asthma deaths found that a significant proportion of patients die without seeking medical assistance or before emergency medical care could be provided.¹

Objectives Establish the pathway that patients undertake to access care in the lead up to an A and E attendance and/or inpatient admission.

Method Patients attending A and E and/or following an inpatient admission due to an exacerbation of asthma or COPD were reviewed by a respiratory pharmacist during weekday working hours. Patients were identified during post take ward rounds and using hospital electronic systems. All analyses were conducted using SPSS 22. Ethics approval was not required.

Results Over the six-month period, 539 (138 asthma and 403 COPD) presentations for exacerbations of asthma and COPD were reviewed. As Table 1 shows, only 48% (n = 66) and 46% (n = 185) of asthma and COPD patients respectively, received medical attention and/or had an active intervention (e.g. administration of rescue pack of oral corticosteroids and/or antibiotics) prior to presenting to hospital. The remaining 52% (n = 72) and 54% (n = 218) respectively either did not seek medical attention or were unable to be reviewed (e.g. unable to obtain an appointment with their general practitioner, GP) prior to their attendance. The results also show that the majority of patients were registered with a GP.

Conclusion Despite the majority of patients having access to a GP, a significant proportion of asthma and COPD patients either did not seek medical attention prior to presenting to hospital, or were unable to be reviewed by their GP. These findings correlate with those found in the national review of asthma deaths.¹ At a time of increasing demands on healthcare resources, these results pose the question of how we can better triage patients to appropriate care settings to minimise unscheduled care and improve patient access and care.

Reference

1. Royal College of Physicians. Why asthma still kills: the National Review of Asthma Deaths (NRAD). Confidential Enquiry Report. May 2014