Institute of Applied Health Research, University of Birmingham, Edgbaston, West Midlands, B15 2TT, UK.
Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Newcastle Road, Staffordshire, ST4 6QG, UK.
NPJ Prim Care Respir Med. 2024 May 1;34(1):7. doi: 10.1038/s41533-024-00365-y.
Biologic treatments can alleviate severe asthma symptoms and reduce health service use. However, service capacity limits and low referral rates from primary care indicate unmet patient need. We report a mixed-methods evaluation of an enhanced severe asthma pathway implemented in Staffordshire and Stoke-on-Trent, UK which aimed to optimise primary care referrals through training/education, and increased capacity in specialist clinics. Quantitative analysis assessed patient wait times between pathway stages, prescribing changes, exacerbations, hospital admissions and asthma control. Interviews with 12 stakeholders evaluated perceptions of the enhanced pathway across settings. In 12 months, 564 patients from 28 general practices were reviewed for biologics eligibility, of whom 125 (22.2%) were referred for specialist assessment. Wait times were significantly lower under the enhanced pathway when compared against historic patients following the standard pathway, and reduced overall from a mean of 76.4 to 26.7 weeks between referral and biologics initiation (p < 0.001). Patients commencing biologics (n = 46) showed significantly reduced reliever inhaler prescribing rates (p = 0.037), 60% lower oral steroid use (p < 0.001), significantly reduced exacerbation rates (p < 0.001) and fewer hospital admissions (p < 0.001) compared with the 12 months pre-treatment. Mean asthma control scores reduced from 3.13 pre-initiation to 1.89 post-initiation (p < 0.001) - a clinically significant improvement. Interviewees viewed the enhanced pathway positively, although ongoing issues related to difficulties engaging primary care amid concerns around increased workloads and pathway capacity. The large number of referrals generated from a comparatively small number of general practices confirms substantial unmet need that an enhanced severe asthma pathway could help address if implemented routinely.
生物制剂治疗可以缓解严重哮喘症状并减少卫生服务的使用。然而，由于服务能力有限以及初级保健的转诊率较低，表明存在未满足的患者需求。我们报告了英国斯塔福德郡和特伦特河畔斯托克市实施的强化严重哮喘途径的混合方法评估，该途径旨在通过培训/教育以及在专科诊所增加能力来优化初级保健转诊。定量分析评估了患者在途径各阶段之间的等待时间、处方变化、加重、住院和哮喘控制情况。对 12 名利益攸关方的访谈评估了该强化途径在不同环境中的看法。在 12 个月内，对来自 28 家普通诊所的 564 名患者进行了生物制剂资格审查，其中 125 名（22.2%）被转介进行专科评估。与标准途径下的历史患者相比，强化途径的等待时间显著降低，转诊至生物制剂开始治疗的总时间从平均 76.4 周缩短至 26.7 周（p<0.001）。开始使用生物制剂的患者（n=46）的急救吸入器处方率显著降低（p=0.037），口服类固醇使用率降低 60%（p<0.001），哮喘加重率显著降低（p<0.001），住院人数减少（p<0.001）与治疗前 12 个月相比。哮喘控制评分从起始前的 3.13 分降至起始后的 1.89 分（p<0.001），这是一个临床显著的改善。受访者对强化途径持积极态度，尽管由于工作量增加和途径容量方面的担忧，初级保健参与存在持续问题。从相对较少的普通诊所产生的大量转诊证实了大量未满足的需求，如果常规实施强化严重哮喘途径，可以帮助解决这些需求。
