P194 Assessing variation in severe asthma care in England: a national benchmarking study

• Published in: Thorax Vol. 77; no. Suppl 1; p. A185
• Main Authors: Rose, J, Gadhia, S, Lepetyukh, M, Rupani, H, d’Ancona, G
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 11.11.2022; BMJ Publishing Group LTD
• Subjects: Asthma; Primary care; ‘Catch Me If You Can’ – Opportunities to improve care in airways disease; United Kingdom > UK; England
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2022-BTSabstracts.328

BackgroundTo improve access to severe asthma services across England, an understanding of variation in delivery models, pathways and practice is critical.AimThis study aimed to assess variation in severe asthma care across primary care, secondary care and tertiary care in England.MethodsOrganisations involved in severe asthma care in England were invited to join this benchmarking study. Semi-structured interviews were conducted with respondents between March and May 2021. Responses were analysed using quantitative and thematic analysis techniques.Results220 different organisations in England responded across different care settings. 3 key areas of variation emerged as most significant.1) Patient Identification: Processes for identification of uncontrolled asthma in primary care were varied. Most reported reactive models, with only 18% of respondents employing proactive approaches to identify at-risk patients. In addition, education around uncontrolled and severe asthma was highly variable with over 50% of primary care respondents reporting not having received any formal training or education.2) Clinical Staff Resource: 68% of tertiary care respondents reported clinical staffing limitations as the most significant barrier to service improvement. Over 30% of tertiary care respondents reported having no designated adherence lead and 48% reported poor access to essential psychology support.3) Pathway capacity: 36% of tertiary care respondents reported other capacity challenges limited by: infrastructure (physical space available for clinics and testing); access to administrative support and technology to improve data flows.ConclusionSignificant variation was observed in several areas of service provision. This work highlights an opportunity to rethink pathways and services for severe asthma patients to address unwanted variation and to improve access to severe asthma care.