Improving Quality of Care of Patients with Acute Asthma Exacerbations in Primary Care Health Clinic in Port Dickson District, Malaysia

Clinical Research Results Abstract Research Idea Abstract Service Development & Evaluation Abstract Aim: To improve asthma care plan during acute exacerbation focusing on the work process for patients attending four primary health clinics in Port Dickson District, Malaysia and to achieve good asthma control following exacerbation. Context: In Malaysia, patients who present with acute asthma exacerbations at government primary care clinics are often assessed and managed by paramedics in the emergency area of the clinic. Findings from clinical audit in four health clinics showed incomplete clinical assessment and subsequent care plan for patients with acute exacerbation. Only 32% (14/44) and 36% (16/44) were asked about history of emergency visit and hospital admission in the past one year. Asthma severity were only documented in 43% (19/44) and there was no documentation on peak flow assessment. On discharged, only 32% received education on asthma and 23% had revision on asthma treatment. Only 54% received appropriate follow up plan on dischargedStrategy: We attended three workshop sessions involving asthma teams from these four health clinics and patients with asthma, organized by experts from the RESPIRE team to help facilitate exploring issues and finding strategies for implementation of better asthma care adapted to local system. Interventions: Create an asthma registry for patients presented with acute exacerbation, initiate use of clerking sheets in asthma bay for paramedics and doctors, revise asthma exacerbation work process and emphasize use of Asthma Action Plan based on current guideline.Lessons learned: The use of asthma registry aid in identification of patients with uncontrolled asthma and facilitates monitoring and progress. The use of clerking sheets aid in comprehensive assessment and the asthma exacerbation flow chart guide the paramedics in particular on subsequent asthma care. This is the first local initiative done to improve asthma care for acute exacerbation. The initiative is well accepted by primary care providers as it is incorporated within the existing core services. Declaration of Interest None References and Clinical Trial Registry Information 1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2021. Available from: www.ginaasthma.org.2. Ministry of Health, Malaysia. Management of Asthma in Adults Putrajaya: MoH; 2017.