Article Text

G435(P) An integrated care approach to improve asthma services in a gp practice
  1. R Ravindran1,
  2. R Kumar2,
  3. N Mclaughlin2,
  4. C Macaulay1
  1. General Paediatrics, Evelina London Children’s Hospital, London, UK
  2. General Practice, Millbank Medical Centre, London, UK


Aims To improve asthma services for children less than 16 year of age registered with a General practice by integrated care approach between general practitioners (GP’s) and paediatricians.

Methods 1. An audit on children under 16 years of age identified 33 children who were issued >/=2 Salbutamol inhalers between February 2015 and January 2016 at the GP practice. By reviewing documentation on database, local practice was audited against London asthma standards (2015) based on National review of asthma deaths (NRAD).

2. We arranged reviews for children with asthma diagnosis in the ‘Learning together’ (LT) clinics at the GP practice over 3 months. The aim of the joint GP/paediatrician led clinic was to assess asthma control and optimise management using structured proforma.

3. Local pharmacy visits were conducted to review information provided to families during inhaler prescription collection.

Results 18% (6/33) of children were high risk and had been prescribed >/=10 Salbutamol inhalers. 55% (18/33) of children were due for annual asthma reviews. Inhaler technique review and adherence to treatment was checked in only 36% (12/33) and 15% (5/33) of patients respectively. Only 9% (3/33) of children had been issued a personalised asthma plan. We conducted structured asthma reviews on 14 children in LT clinics and contacted 4 children via telephone consult, followed by issue of asthma plans. We corrected inhaler technique for 43% (6/14) patients; spacer upgraded for 71% (10/14) and optimised treatment for 36% (5/14) patients. Smoking cessation advice was offered to 2 parents. All patients reviewed in clinic were discussed at the joint GP/paediatrician hub meetings. Visits to 4 local pharmacies revealed that inhaler advice was routinely offered to families during prescription collection.

Conclusions 1. Creating awareness among GP’s and paediatricians on NRAD recommendations is important to improve asthma care. Towards end of the project, the proportion of children with asthma plans increased from 9% (3/33) to 55% (18/33).

2. The LT clinics identified gaps in patient and parent knowledge of asthma. 71% of the parents found the LT clinic reviews helpful.

3. Collaborative working between GP’s, paediatricians and pharmacists is essential to improve asthma services in community.

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