‘MISSION’ is a Quality Improvement, Patient Safety and Innovation project that aims to reduce the length of time before uncontrolled asthma is recognised and treated thus improving patient experience and reducing costs.
In line with recommendations in the National Review of Asthma Deaths (NRAD), we identified patients with high-risk asthma from GP registers and conducted thorough assessments through MISSION Rapid Access Asthma Clinics (RAAC) and Severe Asthma Assessment Clinics (SAAC).
MISSION Rapid Access Asthma Clinics (RAAC)
The Rapid Access Asthma Clinics were run in a 'carousel station' style to assess patients over four separate Saturdays in GP practices in Portsmouth City, Gosport, Havant and Winchester.
The RAAC delivered a comprehensive asthma review including, medical assessment, spirometry, measurement of eosinophilic inflammation, allergy skin testing, smoking cessation as appropriate, and asthma education.
At the end of the clinic, patients received an individual self-management plan and peak flow diary. This was followed up with a personalised asthma report combining all the test results and advice from the clinic, including trigger avoidance and comorbidity treatment recommendations. There was a clear focus on education with an interactive presentation, self-management plan and personalised report to empower patients to manage their asthma. Patients were given information on asthma medication and how to recognise when asthma is not well controlled and importantly, what to do – a key recommendation following the NRAD report.
MISSION Severe Asthma Assessment Clinics (SAAC)
The Severe Asthma Assessment Clinics held at Queen Alexandra Hospital assessed 22 patients identified from the RAAC as needing further assessment. The multidisciplinary team included asthma specialist consultants, asthma nurses, physiologists, physiotherapist, dietician, ENT and psychologist. Comorbidities were identified at the RAAC through a combination of questionnaire and clinical assessment, leading to review by appropriate specialists.
All patients were given a medical review, physiotherapy and lung function tests. HRCT chest and sinuses were available if clinically indicated. At the end of the SAAC, a Multi Disciplinary Team (MDT) meeting was held. Patients and their GP then received a detailed report and plan for further treatment and follow up.
The use of a multidisciplinary team from primary and secondary care has both immediate and long-term patient benefits. The immediate benefits include diagnostic clarity and early phenotype-guided asthma management. The long-term benefits are the up-skilling of healthcare professionals through collaborative working, embedding evidence-based practice and improving opportunities to participate in research.