The Sentinel Project: experience-based co-design of an implementation-ready intervention to improve adult asthma care in primary care

AimTo co-design an implementation-ready intervention to be deployed across Hull Primary Care Networks as part of a collaborative quality improvement project (Sentinel). Sentinel aims to improve asthma outcomes and reduce the environmental impact of asthma inhalers by promoting adoption of the Hull adult asthma guideline which endorses a SABA-free strategy for BTS step 3 patients [1]. Outline of ContextShort acting beta agonist (SABA) overuse (prescription of ≥3 canisters per year) is associated with worse asthma outcomes including exacerbations and death [2]. The NHS long term plan endorses asthma treatment optimisation while minimising the environmental impact of inhaled therapies. SABAs account for the majority of UK greenhouse gas emissions from asthma inhalers [3] and in Hull, 37% of asthmatics receive ≥6 SABAs/year [4]. Tackling SABA overuse will be essential to improve asthma outcomes and reduce the environmental impact of inhalers.Description of the interventionA multi-faceted intervention was developed using a condensed Experience-based Co-Design (EBCD) process comprising: exploratory meetings with NHS staff (=7); staff feedback event; exploratory meetings with asthma patients (=3); joint patient-staff co-design event.The co-designed intervention comprises five pillars: Healthcare professional education; implementation of ‘gold standard’ prescribing practices; targeted asthma reviews; patient education and support; and real-time data monitoring and reporting of asthma care metrics. Co-design contributed to all intervention components and provided insights into potential implementation issues (e.g. workload, electronic repeat prescribing, and cross-system consistency).Strategy for ChangeThe intervention will be implemented across the Primary Care Networks in Hull over 10-months using a stepped wedge design to facilitate robust evaluation and evidence generation.Message for OthersIt is feasible to develop a multifaceted quality improvement intervention to tackle SABA overuse through co-design, engaging local patients and clinicians in order to overcome potential implementation barriers.ReferencesHull and East Riding Guideline for the treatment of adult asthma. Accessed on 05/02/2020 Available from: https://www.hey.nhs.uk/wp/wp-content/uploads/2016/03/treatmentAdultAsthma.pdfNwaru BI, Ekström M, Hasvold P, Wiklund F, Telg G, Janson C. Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J. 2020 Apr 16;55(4):1901872. Janson C, Henderson R, Löfdahl M, Hedberg M, Sharma R, Wilkinson AJK. Carbon footprint impact of the choice of inhalers for asthma and COPD. Thorax. 2020 Jan;75(1):82-84.Respiratory Outcomes. Available at: https://www.respiratoryoutcomes.co.uk Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest The project was funded by AstraZeneca UK. References and Clinical Trial Registry Information