Abstract

Background: We have previously reported on the benefits of a computer guided consultation (CGC) when undertaking COPD reviews within primary care. This study aims to evaluate the impact of implementing such technology in the setting of primary care Asthma reviews.

Methodology: The CGC (LungHealth Ltd) is an intelligent decision support system ensuring accurate guideline-based staging of Asthma and assessment of Asthma control with the software subsequently prompting guideline-standard management. Patients on Asthma registers in Greater Manchester PCNs were identified and underwent remote review with video consultation by nursing staff using the CGC linked directly to the GP clinical system.

Results: 139 patients (age 59 (SD 18) years; 61% Female; ACT score 18 (SD 5)) were reviewed. The CGC reported “poor” Asthma Control in 66% (91/139) whilst 41% (57/139) had required >=1 oral steroid courses and 63% reporting >=6 cannisters of SABA reliever use in the past 12 months. 22% (31/139) were found not to have a personalised Asthma management plan during CGC review which was alerted by the CGC and subsequently, all but one patient had this created on review completion (McNemar’s test; p<0.001). 5% (7/139) were found not to have been prescribed regular Inhaled steroid therapy, this also being alerted by the CGC resulting in inhaled steroid therapy being initiated. Good control was reported by the CGC in 24% (34 patients including 15 at “Additional controller” and 8 at “Specialist Therapies” stages) with the software prompting stepping down therapy where appropriate. Overall, 42% (58/139) were recommended by the CGC to need alteration in Asthma therapy following review.

Conclusion: The utilisation of a CGC when conducting primary care Asthma reviews increases implementation of guideline-level management thus addressing health inequality whilst guiding therapy step down specifically in the context of good Asthma control and enabling identification of “high risk” Asthma patients.