Do primary care clinicians in England have access to Fractional exhaled Nitric Oxide (FeNO) testing within practice and do clinicians feel adequately prepared to utilise FeNO testing for the diagnosis and management of asthma?
Being a dissertation in partial fulfilment of the MSc in Advanced Clinical Practice in the University of Hull (ID 435)
University of Hull
Funding: My employer City Health Care Partnership CIC paid for publishing of the survey via SurveyMonkey.
Abstract
Hypothesis:'Most primary care clinicians do not have access to FeNO in practice and there is an unmet need for quality assured training in FeNO performance and interpretation’.
Background:
This study investigated current access to FeNO testing in English primary care and it identified barriers and/or facilitators to FeNO adoption.
Methods:
SurveyMonkey published a survey between 01st August 2022 and 16th October 2022; it was distributed via PCRS, English GP Bulletins, LMC newsletters, the RCN, the AHSN, NHS Futures, University of Hull, CHCP media outlets, Facebook, Twitter, and Linkedin.
The survey collected:
Socio-demographic data.
Self-reported knowledge of FeNO.
Previous accredited/non-accredited training & if completed before use.
Confidence & history of FeNO use.
Pre-test counselling.
Perceived training needs.
Results:
Following exclusions, 267 respondents from all NHS England regions were included. Barriers to FeNO test adoption included:
• No access.
• No previous training.
• Cost.
• Unaware of FeNO.
Other findings:
• 38% respondents have access to FeNO.
• 9% of clinicians in 'London' and 'East of England' have FeNO access compared to 67% in 'South-West'.
• Previous training:
• 25% accredited
• 36% non-accredited.
• 84% use FeNO for asthma diagnosis and management.
• 53% complete pre-FeNO test counselling.
• 9% very confident to diagnose asthma at 40ppb.
• 41% rated confidence to interpret FeNO at ≥ 5/10.
• 40% rated confidence to perform FeNO at ≥ 5/10.
• 71% requested accredited practical and theoretical training.
Conclusion:
Access to FeNO varies significantly across England. NHS regions may need enhanced funding and support to address inequalities to FeNO access and manage existing barriers to FeNO adoption.
Sub-optimal use of pre-FeNO test counselling could be reducing test specificity/sensitivity. Accredited practical and theoretical FeNO training and a competency framework should be considered to improve clinician confidence and performance of quality assured FeNO testing.
Conflicts of interest: None
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