Education and CPD

29 Mar 2016

Down with DNAs – get more, well-prepared patients attending their asthma reviews

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Collette Harris, Head of Health Advice at Asthma UK

As you know, annual asthma reviews are a key part of asthma management. An effective review helps to lower the patient’s risk of having a potentially life-threatening asthma attack, and also reduces their chances of day to day symptoms that drive them back to you for repeat consultations.

BTS/SIGN guidelines state that everyone with asthma should have a review at least once a year. So it can be frustrating when you don’t feel you’ve got the most out of review time with a patient and you suspect they’ll soon be back - or, worse, when they don’t show up for their review in the first place.

After talking to a wide variety of healthcare professionals and patients, Asthma UK has produced a set of simple practical tips proven to help reduce the number of missed reviews – and increase the efficiency of the consultation. The tips are based on real-life trials from practices that achieved improved efficiency and asthma outcomes. We’d love to know which ones you already use and rate highly, or get feedback on new ones that do the trick for you. These tips fall into four broad areas…

Ways to encourage patients to attend:

Send out motivational invitation letters 2-3 weeks ahead of annual asthma reviews (try our templates). These give patients time to plan to attend and clear instructions on how to prepare, such as bringing their inhalers.

Consider sending low-cost text reminders – one study found they reduced DNAs by 38%. Or try email reminders, too. Forgetfulness is often the reason patients miss appointments.

Ensure patients put their next appointment in their diary or smartphone calendar before leaving the practice.

Use posters showing positive attendance rates instead of DNAs. One practice did this, alongside other initiatives, and found it reduced DNA rates by 32%.

Making best use of consultation time:

Ask patients to bring a video of their symptoms. Watching a video clip in a consultation is often faster than asking patients to accurately remember or describe their symptoms – especially if they’re not symptomatic on the day. This can be especially useful to help you consult with patients who have language barriers, or have a distorted view of how serious their symptoms really are.

Get patients to think about their asthma control before the appointment, to save time and help them get more from their review. You could include the 3 RCP questions or the Asthma Control Test in appointment letters - or hand them out in asthma clinic waiting rooms.

Achieving QoF targets more easily:

Try to schedule asthma reviews for times that are likely to be more convenient or symptomatic for certain patient groups. For example, invite children during school holidays or during hay fever season.

Try asthma reviews by phone to save time and money. This can also be more convenient for patients who work full-time. And the latest research shows telephone reviews are just as effective for patients with mild or well-controlled asthma. Remember: asking the 3 RCP questions over the phone counts towards QOF points too.

Reducing unnecessary appointments:

Use personal written asthma action plans to reduce emergency primary care appointments. Filling out an Asthma UK asthma action plan (now available on EMIS Web) with the patient has been found to reduce emergency appointments at GP surgeries by supporting self-management, providing patients take a copy home.

Almost a fifth of GP appointments are taken up by people who don’t need them. Signpost patients to reputable information and support services. Asthma UK provides wide-ranging advice at www.asthma.org.uk (Information Standard accredited) and through its Helpline.

If you have any questions about asthma reviews or any other aspects of asthma care, the Asthma UK Helpline nurse team is here to support healthcare professionals as well as people with asthma, so call them on 0300 222 5800 (Mon-Fri, 9am-5pm). And if you’ve got tips on improving the take-up and effectiveness of asthma reviews, we’d love to hear them – email our Head of Health advice, Colette Harris, on charris@asthma.org.uk

We hope you’ve found this post useful – look out for our next one on asthma action plans.

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