The MISSION Asthma Project
‘MISSION’ is a Quality Improvement, Patient Safety and Innovation project of the Wessex Asthma Network and Wessex Academic Health Sciences Network that tested the acceptability and delivery of a novel model of asthma assessment and care. Following on from recommendations in the National Review of Asthma Deaths (NRAD) we proactively identified patients with high risk asthma from GP registers and then conducted swift and thorough assessment through MISSION Rapid Access Asthma Clinics (RAAC) and Severe Asthma Assessment Clinics (SAAC). The aim of MISSION was to reduce the length of time before uncontrolled asthma is recognised and treated thus reducing health costs and improving patient experience.
MISSION RAAC
The Rapid Access Asthma Clinics were “carousel station” style assessing patients to above NICE Quality Standards over 5 separate Saturdays in GP practices in Portsmouth City, Gosport, Havant,Southampton and Winchester.
The RAAC delivered a comprehensive asthma review. This included medical assessment, spirometry, measurement of eosinophilic inflammation, allergy skin testing and smoking cessation advice, if required, as well as an education session. At the end of the clinic patients received an individual self management plan and peak flow diary. This was followed up with a personalised asthma report combining all the test results and advice from the clinic, including trigger avoidance and comorbidity treatment recommendations.
There was a clear focus on education with an interactive presentation, self-management plan and personalised report to empower patients to manage their asthma. The education session included information on asthma, medication and triggers as well as ways to recognise when asthma is not well controlled and what to do – a key recommendation following the NRAD report.
MISSION SAAC
The Severe Asthma Assessment Clinics held at Queen Alexandra Hospital assessed patients identified from the RAAC as needing further assessment. The multidisciplinary team included asthma specialist consultants, asthma nurses, physiologists, physiotherapist, dietician, ENT and psychologist. Comorbidities were identified at the RAAC through a combination of questionnaire and clinical assessment leading to review by the appropriate specialists. All patients underwent medical review, physiotherapy and lung function and on the day HRCT chest and sinuses were available if clinically indicated.
At the end of the SAAC a Multi Disciplinary Team (MDT) meeting was held. Patients and their GP then received a detailed report and plan for further treatment and follow up.
The feedback from patients and staff was overwhelmingly positive. Patients reported an increase in their confidence in managing their asthma and all patients would recommend the clinic to their family or friends if they had asthma. The clinics were held on Saturdays to suit the needs of asthma patients, many of whom are working or studying full-time.
Several patients have also written to the team with their experiences:
‘Sitting at home and reading through all the various notes than had been written, the information in the asthma guide, and the new prescriptions which would better help me with my asthma. I had a thought that for the first time in my life, I understood it, and I know how to lessen the effect. I actually feel I am now, in complete control of my condition – it no longer worries me.’
‘I am writing regarding the Specialist Access Asthma Clinic I attended on the 19th July. This clinic was a fantastic opportunity to meet and have my asthma and breathing assessed by a variety of specialists in a quick and efficient manner. I thoroughly enjoyed the experience and would strongly recommend to a friend or family who was suffering with asthma.’
‘I would like to say how impressed I was with the Rapid Access Asthma Clinic. The variety of expert seen in the time allotted and the speed of the whole operation was excellent. If only other NHS clinics ran like this.’
MISSION severe asthma is a new innovative way to identify, assess and treat patients with uncontrolled and potentially severe asthma rapidly in way that includes thorough assessment, patient education and empowerment and multi disciplinary working. Patients with uncontrolled asthma are at risk of death as well as having reduced quality of life and high health care usage. The early results show an improvement in patient knowledge and confidence, asthma control and reduction in asthma exacerbations and health care use.
HSJ Value in Healthcare Awards 2015
We are absolutely delighted that the MISSION Asthma project won a prestigious national HSJ award in September 2015.
The award category was Value in Healthcare Awards: Value and Improvement in the use of Diagnostics.
The judges said: “Our winner has a fantastic multidisciplinary team approach. The impact is excellent, well evaluated and it works with high risk patients, which in the longer term will reduce death rates.”
For more information on the HSJ Value in Healthcare awards visit the website here.
For more information on the MISSION asthma project please contact the Research and Innovation Department at Portsmouth Hospitals NHS Trust.
