Models of care for severe asthma: the role of primary care

Chung, Li Ping; Johnson, Paula A.; Summers, Quentin

doi:10.5694/mja18.00119

Cited by 23 publications

(28 citation statements)

References 38 publications

(87 reference statements)

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“…A cross‐sectional Australian survey showed only 10% of patients consulted a specialist for their condition despite a substantial asthma burden . To best triage patients with severe asthma, it is important for medical training programmes and materials to include specific referral criteria and guidance on critical information to include in a referral letter …”

Section: Barriers To and Solutions For Changementioning

confidence: 99%

“…An estimated one in eight severe asthmatic patients already under the care of a specialist could further benefit from referral to an asthma service for MDA review . Severe asthma services are often limited by funding or resource restrictions including inadequate clinical or allied health staffing, and there is scope to improve collaboration and integration of severe asthma services with primary care …”

Section: Barriers To and Solutions For Changementioning

confidence: 99%

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Rational oral corticosteroid use in adult severe asthma: A narrative review

et al. 2019

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OCS play an important role in the management of asthma. However, steroid-related AE are common and represent a leading cause of morbidity. Limited published studies suggest OCS usage varies across countries and recent registry data indicate that at least 25-60% of patients with severe asthma in developed countries may at some stage be prescribed OCS. Recent evidence indicate that many patients do not receive optimal therapy for asthma and are often prescribed maintenance OCS or repeated steroid bursts to treat exacerbations. Given the recent progress in adult severe asthma and new treatment options, judicious appraisal of steroid use is merited. A number of strategies and add-on therapies are now available to treat severe asthma. These include increasing specialist referral for multidisciplinary assessments and implementing OCSsparing interventions, such as improving guideline adherence and add-on tiotropium and macrolides. Biologics have recently become available for severe asthma; these agents reduce asthma exacerbations and lower OCS exposure. Further research, collaboration and consensus are necessary to develop a structured stewardship approach including realistic OCS-weaning programmes for patients with severe asthma on regular OCS; education and public health campaigns to improve timely access to specialized severe asthma services for treatment optimization; and implementing targeted strategies to identify patients who warrant OCS use using objective biomarker-based strategies.

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Section: Barriers To and Solutions For Changementioning

confidence: 99%

Section: Barriers To and Solutions For Changementioning

confidence: 99%

Rational oral corticosteroid use in adult severe asthma: A narrative review

et al. 2019

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“…Mechanism for involving primary care : Scope exists for better communication and collaboration with GP in the overall management of severe asthma. This includes opportunities to educate about specific aspects, such as early identification and referral, management of selected comorbidities and how to improve access to community‐based allied health services . It is equally important that clear plans and processes exist for appropriately returning patients to primary care once treatment is optimised.…”

Section: Current Models Of Care For Severe Asthmamentioning

confidence: 99%

“…This includes opportunities to educate about specific aspects, such as early identification and referral, management of selected comorbidities and how to improve access to communitybased allied health services. 21 It is equally important that clear plans and processes exist for appropriately returning patients to primary care once treatment is optimised. This may include specific education and support tools for patients and GP to maximise adherence and ensure safe administration of add-on treatments.…”

Section: Opportunities For Advancing Carementioning

confidence: 99%

Managing patients with severe asthma in Australia: Current challenges with the existing models of care

Chung

Hew

Bardin

et al. 2018

Internal Medicine Journal

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Severe asthma leads to debilitating symptoms for patients and excessive socioeconomic burden for the community. Comprehensive models of care are required to address complex issues, risk factors and comorbidities in patients with severe asthma, and to identify patients most appropriate for specialised treatments. Dedicated severe asthma services improve asthma control, reduce asthma exacerbations and hospital admissions, and improve quality of life. Currently, diverse models of care exist for managing severe asthma across Australia. Most referrals to severe asthma services are from respiratory physicians seeking a second opinion or from primary care for poorly controlled asthma. Despite benefits of specialised severe asthma services, many patients are not referred and resources are limited, often resulting in long waiting times. Patient referral is often unstructured and there are considerable variations in the management of severe asthma with limited access to other health care professionals such as speech pathologists and dieticians, and restricted scope to optimise patient work‐up before referral. Ongoing communication between the specialist and referring clinician is essential for continuity of care but is often lacking. Referral pathways can be optimised by developing referral criteria and guidelines to triage patients with severe asthma and to improve resource efficiency. Additional education and tools for assessing and managing severe asthma are needed, and mechanisms should be developed for involving primary care in the management of stabilised patients. Strategies to increase patient access to multidisciplinary services are recommended.

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“…A big gap exists in the actual delivery of multidisciplinary and coordinated care to people with severe asthma. What is the best model of care for severe asthma in Australia? 6 The UK has opted for quarantining part of its National Health Service budget for specialised services, and has commissioned designated centres that are accredited to deliver severe asthma services 9 , 12 . Is this the best approach for Australia?…”

mentioning

confidence: 99%

Severe asthma: implementing game‐changing science

Gibson

2018

Medical Journal of Australia

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Models of care for severe asthma: the role of primary care

Cited by 23 publications

References 38 publications

Rational oral corticosteroid use in adult severe asthma: A narrative review

Rational oral corticosteroid use in adult severe asthma: A narrative review

Managing patients with severe asthma in Australia: Current challenges with the existing models of care

Severe asthma: implementing game‐changing science

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