Dr Reena Bhatt writes about how the asthma prevalence finder can help young people with asthma better manage their medication, reduce emergencies and improve their wellbeing in the long term
A paper published by Ingrid Woolfe in the Lancet in 2013 highlighted that the UK had the worst mortality and morbidity rates for children with asthma compared to our Western Europe counterparts. We have to ask ourselves why, in a country which has a robust healthcare system, can this be happening? Over the last 10 years various publications, standards and guidelines have attempted to address the issue, all of which say the same thing; let’s get the simple things right.
The National Review of Asthma Deaths highlighted that correct inhaler technique, having an asthma action plan and an adequate annual review were pertinent in managing this common long term condition. It seems straightforward yet we continue to see avoidable deaths in children and young people.
As a clinician, I want to understand the reasons why we still cannot get it right. To do this we need to know its prevalence in the community. The prevalence of asthma in children and young people varies across our capital (it should be around 9-10 per cent) partly due to the system in which we work and the variation in clinical practice. I was fortunate to come across an enthusiastic GP in Lambeth who, with an idea from his paediatric wife, had developed a prevalence finder using simple search criteria on the EMIS system used in primary care.
The prevalence finder was first used by Dr Dyer-Smith in his practice and picked up children and young people who had repeated presentations with cough, wheeze and prescriptions of salbutamol or history of allergies. He was able to improve their understanding of the prevalence and most importantly give a diagnosis of asthma where appropriate so that these children and young people were managed appropriately.
Through the work that we have been doing at Healthy London Partnership (HLP) we have been able to share this tool with other EMIS practices in primary care and have had the tool converted to System One and Vision so that it can be implemented more readily in primary care. In various practices where we have run the tool it has picked up between 80-400 extra patients.
The challenge is ensuring that a sensible review of the case can then be made and where needed these children are then reviewed in the practice, which is no small feat in view of the scarce resources within primary care.
In the short term identifying the patient records and correcting the approach means we can better manage their medication, reduce emergency presentations and improve their wellbeing in the long term.
A prevalence finder should help focus management on the right children and young people and ensure that those at greatest at risk; those that fall in the mild to moderate category, will be diagnosed and managed appropriately by the system as a whole. A vital lesson learnt from the recent tragic asthma deaths in London.
Let’s get the simple things right. A prevalence finder can help achieve this by identifying those at greatest risk. Once identified we can then ensure that the three simple measures; a management plan, inhaler technique and an annual review, are in place.
If you want more information about the prevalence finder please contact: Reena Bhatt (firstname.lastname@example.org) or Sara Nelson (email@example.com). A special thanks to Dr Ross Dyer-Smith, Dr Justin Hayes and Dr Alex Dyer-Smith for creating this tool and sharing it with us.
About the author
Reena Bhatt, BSc (Hons), MBBS, MRCPCH, PG Cert Healthcare leadership, is a senior paediatric trainee, currently doing neonates at UCLH. Whilst training Reena has completed a Darzi fellowship with the Whittington hospital, UCLP and the healthy London partnership. She has just finished a secondment as clinical fellow with the CYP programme at HLP.