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How a Network Incentive Scheme can improve CYP asthma diagnosis and care

18th September 2020

by Tori Hadaway, Community Children’s Specialist Asthma Nurse

The Tower Hamlets Network Incentive Scheme (NIS) challenged GPs to compare their data with that of other practices, aiming to improve standards of care for CYP with wheeze and asthma.

What did they do?

  • Each GP practice searched their database for children prescribed asthma treatments.
  • Children were reviewed and recoded where appropriate.

 What did we find? 

  • 2018-19 saw an increase (4à 5%) in prevalence of coded childhood asthma in TH.
  • This increase is believed to reflect improved coding and therefore treatment accuracy and we expect it to persist in subsequent years driven by the NIS.
  • Asthma plans vary in design between providers and plans are not shared across sectors by families.
  • Tower Hamlets has improved the proportion of CYP with an asthma plan by 6%.

There is a need to improve children’s asthma education amongst prescribers, and to institute changes in practice which could and should be supported by non-traditional stakeholders such as community pharmacist and schools; these agents could additionally identify children with inappropriate spacers or reliever therapy use and refer back to the prescriber to make the requisite treatment changes.

We created standardised asthma and wheeze plan templates which were then encoded as templates onto both hospital (CRS Millennium) and community (EMIS) patient record systems and also shared directly with school nursing, GP and health visiting teams.

The intent is that all children with asthma and wheeze should have an asthma management plan as there is evidence that this reduces hospital admissions. Plans should be reviewed +/- updated at every unscheduled medical attendance and every planned review including the annual review.  Plans should ideally be shared and accessible across the local healthcare system (including school and home) in order to prevent duplication or confusion.

Further work will ensure that all CYP have an asthma plan at school and home. We are developing pathways and systems to synchronise and share these plans electronically from secondary to primary care and vice versa.

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