Inadequate specialist care referrals for high risk asthma patients in the UK: an adult population-based cohort 2006-2017
File(s)
Accepted version
Author(s)
Bloom, ci
walker, samantha
Quint, jk
Type
Journal Article
Abstract
Objective: To improve asthma morbidity and mortality in the UK, national asthma guidelines recommend referral to specialist care for the following high risk groups, after a hospital admission for asthma, ≥3 courses of oral corticosteroids (OCS) in 12-months, an incident high-dose inhaled corticosteroid (ICS) prescription or addition of a fourth asthma drug to a patient’s maintenance regimen. We sought to assess the prevalence and temporal change of referrals to identify unmet needs.
Methods: We used UK electronic healthcare records, 2006-2017, to identify high risk asthma patients managed within primary care. Referrals to respiratory clinics in secondary care were measured, within 3 months before or 6 months after, an incident ICS, third OCS in a year, or fourth asthma drug; or 12 months after a hospital admission for asthma. A nested case-control and conditional logistic regression was used to evaluate factors associated with receiving a referral.
Results: 246,116 asthma patients were eligible. There was a slight increase in secondary care referrals from 2014 onwards but the percentage remained low with <20% in each high risk group referred for specialist care. The factors in the past year that were most strongly associated with receiving a referral were a hospital admission or A&E visit for asthma, ≥3 OCS courses, ≥2 add-on drugs, or high-dose ICS prescription.
Conclusion: The majority of high risk asthma patients were not referred for specialist care, as recommended by national guidelines. Compared to other risk factors, those admitted to hospital were most likely to receive a referral.
Methods: We used UK electronic healthcare records, 2006-2017, to identify high risk asthma patients managed within primary care. Referrals to respiratory clinics in secondary care were measured, within 3 months before or 6 months after, an incident ICS, third OCS in a year, or fourth asthma drug; or 12 months after a hospital admission for asthma. A nested case-control and conditional logistic regression was used to evaluate factors associated with receiving a referral.
Results: 246,116 asthma patients were eligible. There was a slight increase in secondary care referrals from 2014 onwards but the percentage remained low with <20% in each high risk group referred for specialist care. The factors in the past year that were most strongly associated with receiving a referral were a hospital admission or A&E visit for asthma, ≥3 OCS courses, ≥2 add-on drugs, or high-dose ICS prescription.
Conclusion: The majority of high risk asthma patients were not referred for specialist care, as recommended by national guidelines. Compared to other risk factors, those admitted to hospital were most likely to receive a referral.
Date Issued
2019-10-09
Date Acceptance
2019-09-22
Citation
Journal of Asthma, 2019, 58 (1), pp.19-25
ISSN
0021-9134
Publisher
Taylor & Francis
Start Page
19
End Page
25
Journal / Book Title
Journal of Asthma
Volume
58
Issue
1
Copyright Statement
© 2019 Taylor & Francis. This is an Accepted Manuscript of an article published by Taylor & Francis in the Journal of Asthma on 24 September 2019, available online: https://doi.org/10.1080/02770903.2019.1672723
Sponsor
Asthma UK
Identifier
https://www.tandfonline.com/doi/full/10.1080/02770903.2019.1672723
Grant Number
RP2N1144
Subjects
Science & Technology
Life Sciences & Biomedicine
Allergy
Respiratory System
Guidelines
high-dose inhaled corticosteroid
oral corticosteroid
hospital admission
electronic healthcare records
ALLERGY
Guidelines
electronic healthcare records
high-dose inhaled corticosteroid
hospital admission
oral corticosteroid
1103 Clinical Sciences
1117 Public Health and Health Services
Allergy
Publication Status
Published
Date Publish Online
2019-09-24