Asthma is a disease that can make it hard for people to breathe. For some people, asthma is well controlled and they have minimal/no symptoms. For other people, they can have day to day symptoms and their disease is not considered controlled. UK guidelines recommend management that could improve outcomes but, for a range of reasons, some patients do not engage with health services. People may not realise that more can be done to help them improve their asthma, they may find it hard to access the right care at the right time, they may not take their inhalers as recommended and people with ‘difficult-to-control’ asthma may struggle to attend appointments at a hospital clinic many miles away. People from ethnic minority groups, deprived communities, or living in remote areas may have problems accessing appropriate care for their asthma. We know that for these people, asthma outcomes are often worse.
This work is part of a larger grant, where our long-term aim is to improve services so that people can access and engage with care that meets their individual needs and preferences. In this preliminary work, we will use routine healthcare data to explore how people use (or do not use) asthma services (for example, do they attend their annual asthma reviews) and determine if there are certain factors that predict who does not engage with healthcare services. One of the groups we are particularly interested in are those at greatest risk of poor asthma control (frequent asthma attacks).
Despite three decades of evidence-based guideline recommendations, UK asthma outcomes are worse than other high-income European countries. Patients often miss review appointments and/or take their asthma preventer treatment infrequently. Whist UK guidelines recommend management that could improve outcomes, for a range of reasons, best (or even adequate care) is too often not accessible or does not engage patients. People may not realise that more can be done to help them improve their asthma, they may find it hard to access the right care at the right time, they may not take their inhalers as recommended and people with ‘difficult-to-control’ asthma may struggle to attend appointments at a hospital clinic many miles away. People from ethnic minority groups, deprived communities, or living in remote areas may have problems accessing appropriate care for their asthma. We know that for these people, asthma outcomes are often worse.
Using routine primary care data from Clinical Practice Research Datalink Aurum linked with deprivation status (IMD) and rural-urban classification, Hospital Episode Statistics (APC, A&E and Outpatient), and ONS mortality data we will determine factors associated with non-engagement in asthma care (e.g. missed annual asthma reviews, poor adherence with treatment). We are particularly interested in understanding if non-engagement is worse in people at greatest risk of poor asthma control (e.g. as defined by frequent asthma attacks/high reliever usage). The study period will be 2010 to the most recent available linked data. We will undertake a cohort study and then explore asthma outcomes (e.g. exacerbations) comparing those who have poor engagement with patients who do not have poor engagement. This work will feed back into a larger NIHR funded study.
We will also build and validate prediction models for non-engagement with adverse events (asthma exacerbations and/or poorly controlled asthma) using logistic regression and consider machine learning methods.
Factors associated with poor engagement with asthma care
Asthma outcomes among people with poor engagement (exacerbations, asthma control, mortality)
Non-engagement with adverse events (asthma exacerbations and/or poorly controlled asthma)
Jennifer Quint - Chief Investigator - Imperial College London
Constantinos Kallis - Corresponding Applicant - Imperial College London
Amy Trinh - Collaborator - Imperial College London
David Lo - Collaborator - University of Leicester
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Rural-Urban Classification