Asthma in Primary Care
Most patients with asthma are managed in primary care settings. Effective outpatient management should lead to reduced hospitalisations. However, many patients still struggle to achieve satisfactory asthma control due to various factors, including the way practices are run and how patients engage with their care. Despite the availability of guidelines and recommendations for asthma management, delivering consistent evidence-based care remains a global challenge. A busy clinic environment often presents obstacles that can result in suboptimal care for patients with asthma. High patient volume can lead to rushed consultations and limited time for thorough assessments and comprehensive management, including patient education.
Quality Indicator of Asthma Care
Frequent evaluation of asthma care is crucial to ensure high-quality treatment for all patients and to identify areas for improvement. Regular audits against evidence-based quality indicators facilitate this process. An organised system, such as a patient care registry that includes specific quality indicators, supports comprehensive and efficient data entry, data management, and easy access for audits. Below are the recommended data elements for an asthma patient care registry in primary care.
1. Asthma Registry Data Element (Appointment)
2. Asthma Registry Data Element (Unscheduled Care)
Asthma Quality Improvement Strategies
Addressing asthma care gaps and challenges requires proactive strategies to facilitate work processes and communication, which are expected to support the delivery of quality care. A multifaceted approach is necessary, involving the improvement of provider knowledge and skills, the implementation of systematic asthma assessment and management, the enhancement of patient education and self-management support, and ensuring access to resources and specialist care when needed.
Strategy 1: Team-based Asthma Care
Strategy 1a: Dedicated Asthma Clinic in Primary Care
An asthma clinic is an organised setting for routine asthma care that occupies a defined and regular time slot or clinical session for reviewing patients with asthma. It describes a proactive system of care situated in a primary care clinic, featuring the organised recall of patients listed on an asthma register. Patients are selected based on pre-specified criteria, such as those with poorly controlled asthma.
Strategy 1b: Team-based Approach to Asthma Care
Ideally, an asthma patient should be managed by a trained asthma team that can provide comprehensive, whole-patient care. A dedicated asthma clinic is established through the teamwork of healthcare providers, focusing on patients with poorly controlled asthma or specific issues that cannot be managed well in a busy outpatient setting.
The aims of the collaborative work between team members are to:
- Conduct individualised analysis of patients' issues and needs.
- Deliver interventions to address these identified issues and measure the outcomes.
- Set common goals for subsequent visits and long-term care.
The core team members include a doctor, nurse or paramedic, and pharmacist. Additional team members, such as a dietitian, physiotherapist, and psychologist, are necessary for multidisciplinary care. Depending on local resources, these professionals may be present in the clinic or available through referral. Roles within the team may evolve, with individuals sometimes needing to meet higher capability requirements through training and credentialing to safely carry out their responsibilities.
Strategy 2: RESPIRE Asthma Care Kit
Strategy 2a: RESPIRE Asthma Care Kit Model
This model consists of two elements:
- Service Element - Defining the processes for the proposed dedicated asthma service in primary care.
- Clinical Element - Defining evidence-based recommendations supported by easy-to-access resources for routine asthma care.
Strategy 2b: RESPIRE Asthma Care Kit
The RESPIRE Asthma Care Kit is a research-based initiative aimed at improving the delivery of asthma care in primary care clinics. This web-based, one-stop resource is designed to help primary healthcare providers, including primary care physicians, medical officers, pharmacists, nurses, and medical assistants, manage asthma more efficiently and effectively. By utilising educational materials and online digital technology, this toolkit provides practical resources and guidance, including articles, infographics, and videos for quick reference. It compiles tools commonly used by healthcare providers during routine reviews and unscheduled clinic encounters. The main focus is on achieving and maintaining good asthma control and quality of life for patients with asthma.
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