How to keep people out of hospital (The impact of a pharmacist-led one stop respiratory clinic)

Background: The Black Country has one of the highest rates of hospital admissions and deaths related to asthma and COPD in the UK. Delays in early and accurate diagnoses, incorrect diagnoses, suboptimal treatment and management and delays in accessing specialised care and treatments can all contribute to poorer respiratory outcomes. Aims and Objectives: To evaluate the impact of a pharmacist-led one stop primary care respiratory clinic on reducing unwarranted variation in respiratory care. Method: A specialist respiratory pharmacist, skilled in diagnosing and managing asthma and COPD, delivered the service. A population health management approach was adopted to identify risk-stratify and manage high-risk respiratory patients and inclusive heath groups with new ways of working with secondary care respiratory experts. The following was evaluated compared to the existing pathway: the time from referral to clinic visit, the time from referral to diagnosis and treatment, the number of misdiagnoses found, the number of patients starting the right treatment plan, improvements in symptom scores, reduced use of reliever medications, the number of secondary care appointments avoided, the number of patients referred from the clinic for asthma biologics, and an assessment of patients' self-management skills before and after the clinic visit. Patient experience was measured using a qualitative questionnaire. Impact and lessons learned: A successful model of proactive care shifting care closer to home. The clinic demonstrates improvement in early and accurate diagnosis of asthma and COPD, shorter referral to treatment times and referral to diagnosis times against existing services. It also improves access to specialist asthma services and treatments in a timely manner. Moreover, patients’ symptoms were better managed, and they were more confident in managing exacerbations. Feedback from all service users was excellent.