Assessing the impact of delivering guideline-based Asthma management in Primary Care: A comparison between Face-to-Face and Remote Consultations in medicines optimisation and carbon footprint reduction (ID 446)
Liverpool University Hospitals NHS Foundation Trust
Funding: The STARRS-GM project has been developed as part of a Joint Working initiative between HInM (Health Innovation Manchester) and AstraZeneca UK. As part of this Joint Working Agreement, Astra Zeneca UK funded the licenses for the use of the LungHealth software, project management costs and the nurse resource to deliver clinics and to perform the initial audit and case-finding.
Abstract
Introduction: We aimed to evaluate the effectiveness of undertaking remote reviews compared to traditional face-to-face consultations when performing Asthma reviews within primary care focusing on adherence to local medicines optimisation guidelines including carbon footprint reduction.Methodology: An analysis was conducted of the first 877 clinic appointments undertaken as part of “Cohort 1” in the GM-STARRS project i.e. patients identified with >=6 SABA inhalers & one other “NRAD” risk factor e.g. Asthma hospitalisation or >=2 steroid courses in the previous 12 months. All patients underwent review using the LungHealth Asthma guided consultation software using Videocall, Face-to-Face (F2F) and Telephone methods.
Results: 877 clinic appointments (29% Videocall, 6% F2F, 65% Telephone) were performed in 748 patients in Greater Manchester Primary Care Networks. Telephone consultation was significantly more likely to trigger need for further review in order to adequately assess inhaler technique in comparison to F2F/Videocall (88.5% v 39.6%/11.7%; Chi squared; p<0.001). Those receiving a telephone consultation were less likely to be switched from a metered-dose inhaler (MDI) to a Dry Powder Inhaler (DPI) device in line with locality NHS net zero policy when compared to F2F/Video consultation (20.2% v 49.8%/51.2% respectively; Chi squared p<0.001). No significant difference was observed in Asthma therapy step-down (5.4% Telephone v 2.3% Videocall v 6.3% F2F) or escalation (22.9% Telephone v 27.3% Videocall v 20.8% F2F) although a specific change to MART therapy was more likely in a F2F review when compared to Video/Telephone consultation (25.5% v 12.4%/12.4% respectively; Chi squared; p=0.018). The mode of consultation did not affect asthma management plan provision (96.9% Telephone v 99.6% Videocall v 97.9% F2F) or smoking cessation referral.
Conclusion: This supports the benefit of Face-to face and video-consultations over telephone consultations when conducting Primary Care Asthma reviews in terms of medicines optimisation and carbon footprint reduction thus shaping future practice.
Conflicts of interest: Drs Chakrabarti, Angus, Davies, Professor Pearson and Mr McKnight are all directors of LungHealth Ltd.
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