Inadequate specialist care referrals for high-risk asthma patients in the UK: an adult population-based cohort 2006–2017

Abstract

Objective

To improve asthma morbidity and mortality in the UK, national asthma guidelines recommend referral to \ specialist care for the following high-risk groups, after a hospital admission for asthma, ≥3 courses of oral corticosteroids (OCS) in 12 months, an incident high-dose inhaled corticosteroid (ICS) prescription or addition of a fourth asthma drug to a patient’s maintenance regimen. We sought to assess the prevalence and temporal change of referrals to identify unmet needs.

Methods

We used UK electronic healthcare records, 2006–2017, to identify high-risk asthma patients managed within primary care. Referrals to respiratory clinics in secondary care were measured, within 3 months before or 6 months after, an incident ICS, third OCS in a year, or fourth asthma drug; or 12 months after a hospital admission for asthma. A nested case-control and conditional logistic regression was used to evaluate factors associated with receiving a referral.

Results

A total of 246,116 asthma patients were eligible. There was a slight increase in secondary care referrals from 2014 onwards but the percentage remained low with <20% in each high-risk group referred for specialist care. The factors in the past year that were most strongly associated with receiving a referral were a hospital admission or A&E visit for asthma, ≥3 OCS courses, ≥2 add-on drugs, or high-dose ICS prescription.

Conclusions

The majority of high-risk asthma patients were not referred for specialist care, as recommended by national guidelines. Compared to other risk factors, those admitted to hospital were most likely to receive a referral.

Keywords:

• Guidelines
• high-dose inhaled corticosteroid
• oral corticosteroid
• hospital admission
• electronic healthcare records

Declaration of interest

None of the funds were related to this work.

Additional information

Funding

Dr. Quint’s research group has received funding from The Health Foundation, MRC, Wellcome Trust, BLF, GSK, Insmed, AZ, Bayer, Chiesi, IQVIA and BI for other projects. Dr. Quint has received funds from AZ, GSK, Chiesi, Bayer, Teva and BI for Advisory board participation or travel. Dr. Quint’s research group received funding from Asthma UK for this work.