Help with identifying your patients - system searches and prevalence data

Part of the implementation process for FeNO is likely to involve thinking about prioritising patient groups who will be suitable for testing. It is likely that practices will already have a 'waiting' list of patients who are awaiting diagnostic testing. In addition to this, there may be groups of patients who have exhibited asthma symptoms and who have been treated for some time with asthma medicines but who do not have a formal diagnosis of asthma recorded in their notes.

A study of GP data from 72 UK general practices (2 CCGs in England and 1 Health Board in Scotland) in 2018*, found that 25% of patients who received at least one respiratory medication in the previous 12 months had no clinical diagnosis recorded for asthma or COPD.

This can mean that people who have asthma, but do not have a formal diagnosis recorded in their notes, are at risk of an exacerbation of their asthma due to sub optimal care and the lack of formal clinical pathway identified for them. Conversely, those who do not genuinely have asthma, may receive respiratory medicines that they do not need.

In order to resolve this area of risk, patients without a recorded, formal diagnosis of asthma or COPD but who are receiving prescriptions for inhalers and or oral prednisolone should undergo review using a diagnostic algorithm for asthma. If FeNO is available to the Practice, it can help the clinician to accurately make the diagnosis of asthma. 

To identify patients who could have their care improved by clarifying their diagnosis, practices can run a simple system search using criteria that can include, for example, specific respiratory symptoms and/or repeat prescriptions of inhalers or oral steroids and/or those coded 'suspected asthma'.

Alternatively Practices can use ePACT2 ePACT2 | NHSBSA / Prescription data | NHSBSA dashboards to generate lists of patients who have been prescribed inhalers and/or oral steroids.

Further examples of case finding and proactive care tools below 

- CDRC Precision digital resources are developed by clinicians in the North East of England, working on existing clinical IT systems (SystmOne and EMIS) and are quality assured by the North of England Care Support Unit (NECS). Dynamic templates help guide and prompt clinical management in line with current best practice. Standardised regional referral information and letters are included, to improve communication, patient care and referral pathways.

You can contact CDRC to access these tools using this link; Resources - Clinical Digital Resource Collaborative (cdrc.nhs.uk)

- UCLP (North West London AHSN) proactive care frameworks provide a platform for optimising clinical care and self-care for people asthma and COPD, supporting primary care teams to do things differently and at scale.

Read the descriptions of the support offered for respiratory conditions below:

• Asthma
• COPD

For more information you can visit UCL Partners Proactive Care Frameworks 

Prevalence data

To understand more about prevalence of asthma and other respiratory diseases we have included examples of accessible supporting data/information below;

https://fingertips.phe.org.uk/search/asthma

https://fingertips.phe.org.uk/profile/inhale

https://openprescribing.net/

https://www.respiratoryfutures.org.uk/

https://www.england.nhs.uk/rightcare/products/nhs-rightcare-intelligence-tools-and-support/

https://www.nhsbsa.nhs.uk/prescription-data

https://statistics.blf.org.uk/asthma

Source: * - P146 Prescribing respiratory medicines without making a diagnosis of Asthma in UK Primary Care | Thorax (bmj.com)