QPS Clinical Effectiveness – Asthma


On the day of the review, the pharmacy can show evidence of asthma patients, for whom more than 6 short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6 month period, are referred to an appropriate health care professional for an asthma review.

10 points per review – can claim points in BOTH April and November 2017, total points = 20.

Aim/Rationale

The aim of this quality criterion is for community pharmacy to contribute to reducing preventable deaths from asthma through surveillance of patients’ use of inhalers. The quality payment encourages contractors to routinely carry out surveillance of patients’ use of inhalers ensuring patients are given appropriate advice and are referred for an asthma review when this is indicated.

The National Review of Asthma Deaths (NRAD) made a number of recommendations to improve the care of people with asthma. This included:

  • people with asthma should have a structured review by a healthcare professional with specialist training in asthma, at least annually
  • all asthma patients who have been prescribed more than 12 short-acting reliever (bronchodilator) inhalers in the previous 12 months should be invited for urgent review of their asthma control, with the aim of improving their asthma through education and change of treatment if required.

Pharmacy professionals are in an ideal position to detect the under and over usage of inhalers by asthma patients through surveillance of patients’ use of inhalers over a fixed period. These interventions may already be commonplace in pharmacies but this quality payment seeks to ensure this vital information is used to trigger an asthma review as recommended by the NRAD report.

Further information on the importance of surveillance of patients’ use of asthma inhalers is included in Annex 4 of the NHSE QPS document.

Reporting

Contractors will be required to declare that they have identified any asthma patients receiving more than six short acting bronchodilator (SABA) inhalers within a six month period without any corticosteroid inhalers being dispensed and they have referred them to an appropriate health care professional. Contractors should retain evidence that this has been carried out in the pharmacy.

Where no patients are identified for referral, the contractor will still be eligible for payment as long as they can evidence that they have been working to identify suitable patients and that they have a process in place for referral should they identify someone. If a patient does not wish to attend for an asthma review the pharmacist should discuss with the patient the risks of uncontrolled asthma and the benefits of preventative treatment and attending an asthma review.  The pharmacy team should support the person to achieve the best asthma control possible. In this case the patient should not be continually referred for review.

The surveillance required focuses on the use of SABA inhalers and could be a combination of one or more of the following:

  • monitoring the number of SABA inhalers dispensed in a rolling 6-month period through the pharmacy patient medication records (PMR) or through routine or opportunistic access to SCR
  • monitoring patient emergency supply requests for SABA inhalers
  • monitoring out of hours or urgent prescriptions for SABA inhalers
  • monitoring emergency supply requests through the NUMSAS service
  • monitoring repeat prescription requests for SABA inhalers
  • monitoring the number of SABA inhaler dispensed as part of a MUR or NMS
  • monitoring non-collection of prescriptions for steroid inhalers

It is up to a pharmacy how they choose to engage and implement regular surveillance of patients’ use of inhalers into their processes and procedures but at a minimum, historical dispensing of SABA and steroid inhalers for patients should be assessed at every point a SABA inhaler prescription is presented for dispensing for the treatment of asthma, without a prescription for a steroid inhaler also being presented at the same time. These tasks could be undertaken by any appropriately trained staff within the pharmacy team.

The contractor will normally be referring the patient to their general practice. The health care professional to whom the patient is referred should be a professional who has undertaken specialist training in asthma. This may be the patient’s GP, GP practice based respiratory nurse specialist or “asthma nurse”.
A data collection form along with supporting materials is available in PSNC Briefing 068/16: Quality Payments – referrals for asthma reviews

PharmOutcomes has prepared a service module for the asthma review to allow you to make referrals to the patient’s GP;  it is available to contractors now.  More details will be given in a future edition of the QPS newsletter.

If you want to look at the module you can find it under the services tab;  the left hand side of the screen shows a list of services under the orange heading “Provide Services”.  These are the services your have been accredited to deliver. You will find the “Asthma Referral tool” here. To make a referral, simply click on the  “Quality Payment criterion – Asthma referrals”  title in the list.
This will take you to the data capture screen.