Obtaining outcome data on asthma management: the UK National Review of Asthma Deaths

Levy, Mark L

doi:10.4104/pcrj.2012.00017

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…It should investigate deaths across all age groups, the circumstances surrounding the death as well as the management of fatal attacks and the quality of care in the preceding 12 months such as that currently being undertaken in the UK. 30 and graphs. The initial draft of the manuscript was prepared by DG and then circulated repeatedly among all authors for critical revision.…”

Section: Future Researchmentioning

confidence: 99%

Asthma mortality in Australia in the 21st century: a case series analysis

Goeman¹,

Abramson

McCarthy

et al. 2013

BMJ Open

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ObjectiveAs previous asthma mortality studies were undertaken between 1986 and 1997, and treatments have evolved since that time, in order to direct future asthma interventions, we investigated the reasons for asthma deaths between 2005 and 2009.DesignWe undertook a case series analysis by searching the National Coroners’ Information System using the most recent International Classification of Diseases-10 codes J45 and J46 and the keyword ‘asthma’ as the underlying cause of death.SettingRecords for 283 cases aged 70 years and under were retrieved from each Australian state and territory. Coroner's findings, autopsy, toxicology and police reports were reviewed to determine: if the team agreed the death was due to asthma and whether the death was preventable or modifiable factors existed? Owing to the likelihood of comorbidities or alternative diagnoses contributing to deaths in those over 70 years of age, this group was excluded.ResultsExamination of available data in those aged under 70 years identified risk factors associated with asthma death. These included physical barriers (rural and remote location, institutionalised care), psychosocial issues (social disengagement, mental illness, living alone, being unemployed), smoking, drug and alcohol dependence, allergies, respiratory tract infections, inadequate treatment and delay in seeking help.ConclusionsOur study provides a current assessment of death from asthma across Australia. Further reductions in the rate of asthma deaths will require interventions targeted at the personal, practice and policy levels. Asthma-related health literacy needs to be improved especially among those with episodic asthma. Reforms are also needed to address inequity in healthcare delivery to ‘reach the unreached’. Our study points to the dangers associated with smoking, drug and alcohol use and the consequences of delay in seeking care among those with asthma.

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Section: Future Researchmentioning

confidence: 99%

Asthma mortality in Australia in the 21st century: a case series analysis

Goeman¹,

Abramson

McCarthy

et al. 2013

BMJ Open

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“…The systemic barriers to the use of AHPs are not isolated to supporting Autistic patients; the UK National Review of Asthma Deaths identified that 70% of the children who died did not have a written asthma management plan, despite the known mortality risk in childhood asthma [ 38 ]. Accordingly, before recommending them as a tool that will reduce health inequality, healthcare systems must be redesigned in such a way that these health passport type tools become a valuable resource, rather than a tokenistic low-cost intervention.…”

Section: Discussionmentioning

confidence: 99%

“I am afraid of being treated badly if I show it”: A cross-sectional study of healthcare accessibility and Autism Health Passports among UK Autistic adults

Grant,

Turner,

Shaw

et al. 2024

PLoS ONE

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Background Autistic people are more likely to experience stigma, communication barriers and anxiety during healthcare. Autism Health Passports (AHPs) are a communication tool that aim to provide information about healthcare needs in a standardised way. They are recommended in research and policy to improve healthcare quality. Aim To explore views and experiences of AHPs among Autistic people from the UK who have been pregnant. Methods We developed an online survey using a combination of open and closed questions focused on healthcare impairments and views and experiences of AHPs. Data were anlaysed using descriptive statistics, Kruskal-Wallis tests, and content analysis. Findings Of 193 Autistic respondents (54% diagnosed, 22% undergoing diagnosis and 24% self-identifying), over 80% reported anxiety and masking during healthcare always or most of the time. Some significant differences were identified in healthcare (in)accessibility by diagnostic status. Only 4% of participants knew a lot about AHPs, with 1.5% of participants using one at least half of the time. Almost three quarters of respondents had not previously seen an AHP. Open text responses indicated that the biggest barrier to using an AHP was a belief that health professionals would discriminate against Autistic patients. Additional barriers included staff lack of familiarity with AHPs and respondents expecting a negative response to producing an AHP. Conclusions Our findings suggest that AHPs are not reducing health inequalities for Autistic adults who have been pregnant. Alternative solutions are needed to reduce health inequalities for Autistic people.

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Asthma at-risk registers — can be effective if carefully constructed and correctly implemented

Noble¹,

Harrison

Windley³

et al. 2012

Primary Care Respiratory Journal

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Dear Sirs,We welcome Stephenson and Shields' timely and important remarks in the recent issue 1 in support of the development and use of asthma atrisk registers. In the same issue, however, Levy raises concerns that some at-risk patients may be overlooked by registers since they do not appear to have severe asthma prior to a fatal or near-fatal attack. 2 We piloted an asthma at-risk register in 2002 3 following two asthma deaths in our practice. Both patients were middle-aged men on British Thoracic Society (BTS) guideline step 4 treatment who were poorly adherent with all aspects of their asthma management, poor perceivers of airflow obstruction, and in denial of their risk. Patients subsequently identified as at-risk had an alert attached to their electronic records which was used to facilitate appropriate emergency and opportunistic management of their asthma and their associated risk factors. We recognised that identifying patients with severe asthma based solely on their BTS treatment step would be over-inclusive and yet would still risk missing under-treated and some poorly adherent at-risk patients. We therefore included a history of hospital admissions or A&E attendances in the identification process. We also recognised that at-risk patients are a heterogeneous group containing a number of phenotypes including brittle, severe refractory and difficult asthma, all of which needed to be considered in the construction of an at-risk register. Patients with difficult asthma were identified by the additional presence of adverse behavioural or psychosocial factors previously shown to be linked to asthma deaths 4 such as poor adherence, psychiatric co-morbidity and, in the case of children, harmful parental factors. Some of these factors are poorly and inconsistently coded on primary care computer systems, so local clinical intelligence was essential to the accurate compilation of the register. We were surprised to find that only 20% of these at-risk patients were attending secondary care outpatient clinics. 3 We have continued to monitor the original cohort of 26 at-risk patients and their age/sex-matched control patients with severe asthma since the register was set-up in 2002. Seventeen matched pairs and 21 original at-risk patients remain registered with the practice. On average, two new patients are added to the register each year (practice list size 9,100). Importantly, longitudinal monitoring of our at-risk patients has shown that there is temporal variation in the nature and degree of risk. This is associated with changes in personal circumstances or life events which impact on psychosocial status or other co-morbidities. Consequently, we retain most patients on the register long-term. Observational data suggest that the benefits of the register documented after the first year 3 have been largely sustained -i.e. there continue to be fewer missed appointments, out-of-hours contacts, emergency courses of oral steroids and hospital attendances in the at-risk group since the introduction of the register, a...

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Obtaining outcome data on asthma management: the UK National Review of Asthma Deaths

Cited by 3 publications

References 5 publications

Asthma mortality in Australia in the 21st century: a case series analysis

Asthma mortality in Australia in the 21st century: a case series analysis

“I am afraid of being treated badly if I show it”: A cross-sectional study of healthcare accessibility and Autism Health Passports among UK Autistic adults

Asthma at-risk registers — can be effective if carefully constructed and correctly implemented

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