Approximately 1 in 9 people in the UK have asthma, but asthma can vary in disease severity. For patients with milder disease their disorder can be managed within primary care. However, for patients with more severe disease, according to clinical guidelines, they should also receive additional input from asthma specialists. This study aims to assess if patients with more severe asthma are being appropriately referred to asthma specialists.
Most asthma patients have mild disease, which does not require much healthcare input, but the needs of the smaller proportion that have more severe disease, are likely to contribute a huge proportion of asthma patients' healthcare needs. Therefore, this study aims to assess the amount of healthcare utilisation asthma patients require, the differences between those with milder or more severe disease, and the difference between those that were or were not referred to secondary care.
This study will provide an understanding of the healthcare needs of patients with more severe asthma and establish if they are receiving appropriate management within secondary care, and the impact of that on their primary care management.
We will identify a cohort of asthma patients that should be referred for specialist respiratory management, according to clinical guidelines or Royal College of Physicians recommendations. These will include (1) asthma patients prescribed a high-dose inhaled corticosteroid (labelled as 'severe asthma') or (2) asthma patients prescribed > 2 prescriptions of oral corticosteroids (OCS) in a year.
We will describe how many severe asthma patients, and those with >2 OCS in a year, were referred to a respiratory specialist (using HES out-patient data). We will also describe their healthcare utilisation (HCU); this will include primary care consultations, secondary care clinics, exacerbations (treated in primary and secondary care), and asthma medications (maintenance and reliever medications). We will stratify this data by asthma severity (based on type of asthma medication), gender, age, socioeconomic status, country and clinical commissioning government (CCG) areas. We will look at the trend of all the outcomes over ten years, 2006 to 2017, by their stratification.
After describing the asthma population in this way we will assess if there is an association between being referred to an asthma specialist and the different components of HCU (except secondary clinics). To do this we will use a multivariate Poisson regression model, and stratify by asthma severity. The model will be adjusted for multiple covariates including, gender, age, socioeconomic status, comorbidities and other respiratory diseases.
Specialist referral
- Asthma medication use
- Primary care consultations
- Asthma exacerbations
Jennifer Quint - Chief Investigator - Imperial College London
Chloe Bloom - Corresponding Applicant - Imperial College London
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation (index other than the most recent)