Multidisciplinary care in chronic airway diseases: the Newcastle model

Abstract

Chronic airway diseases including, asthma and chronic obstructive pulmonary disease (COPD) are prevalent and high burden conditions with the majority of patients successfully managed in the primary care setting. However, some patients with more complex disease such as difficult-to-treat or severe asthma, or complex COPD, tertiary care is required. This review provides an overview of the successful tertiary care multidisciplinary respiratory service that operates in Newcastle, New South Wales, Australia, which has been integrated into the tertiary care outpatient clinics for almost three decades. The service is multifaceted in terms of the clinical care it provides, and includes an “Inpatient service”, “Asthma Management Service”, “Difficult Airway Clinic”, “Drug Administration Clinic”, “Rapid Access Clinic”, “Pulmonary Rehabilitation” and has an integrated research programme. The core of the multidisciplinary approach to airway diseases is a person-centred model of care, the “Treatable Traits” approach. The staffing of this service comprises of consultant physicians, respiratory advanced trainees, respiratory scientists, physiotherapists, speech pathologists, nurse specialists and a nurse consultant. Patients that present to this service undergo an initial assessment and clinical review by team members, synthesis of relevant data, and development of a diagnosis and management plan. Based on this review specific interventions are determined according to the traits identified. Overtime the service has evolved to accommodate the increasing numbers of patients requiring access to the “Difficult Airways Clinic” assessment and therapies. This has been facilitated by partnered with the Centres of Excellence in Severe Asthma and Treatable Traits to develop educational and practice management tools.

Treatable traits, combination inhaler therapy and the future of asthma management

“…Using this teambased approach can take the pressure off time-restricted consultations with the physician alone. 17,58,59 In a study by Majellano et al 56 clinicians also perceived that patient knowledge was often poor and adherence was suboptimal, conversely in a study from McDonald et to know more about their disease and its management from their health care provider and that they frequently 'did not feel heard or recognised'. 53 If we are to effectively translate treatable traits to practice, we must address this discordance.…”

“…Some traits can be addressed by the physician, the nurse/case manager, physiotherapist, speech pathologist, psychologist or dietitian. Using this team‐based approach can take the pressure off time‐restricted consultations with the physician alone 17,58,59 …”

Treatable traits models of care

“…Treatable traits approaches could be implemented without the support of a multidisciplinary team if practitioners are working in isolation, such as rural and remote regions and low and middle income countries 34 . However, the MDT is favoured as it enables expert disciplines to work with the patient to deliver the best outcome 25 . This will reduce the time pressures of the physician and enable multiple traits to be addressed in partnership with individual patients.…”

“…Using this description of models of care, it is easy to see how treatable traits meets these criteria. Using a treatable traits approach, individual patients undergo a multidimensional assessment to identify what we refer to as ‘treatable traits’, and individualized management is delivered according to these findings, often by multidisciplinary teams 25 . Traits are clinically important and treatable therapeutic targets.…”

Paroxysmal dyspnoea in asthma: Wheeze, ILO or dysfunctional breathing?

“…A structured multidisciplinary assessment is therefore recommended in difficult-to-treat asthma ( 17 ), as identifying and managing comorbidities such as DB and ILO can be challenging. Using such an approach is associated with better outcomes than standard care ( 18 ). However, multi-disciplinary subspecialty asthma clinics are relatively rare in many countries, and identifying DB and ILO is an especial challenge in a general Respiratory clinic or in primary care setting where these conditions are less frequently encountered, and the index of suspicion may be lower.…”