The barriers to accessing primary care resulting in hospital presentation for exacerbation of asthma or chronic obstructive pulmonary disease in a large teaching hospital in London

Abstract

Asthma and chronic obstructive pulmonary disease (COPD) account direct costs of £1 billion each per year in the United Kingdom (UK). A national review of asthma deaths found that a significant proportion of patients die without seeking medical assistance or before emergency medical care could be provided. This study aims to establish the pathway that patients undertake to access care in the lead up to an accident and emergency (A&E) attendance and/or inpatient admission. Patients attending A&E and/or following an inpatient admission due to an exacerbation of asthma or COPD were reviewed by a specialist respiratory pharmacist during weekday working hours. Over a one-year period, 920 (224 asthma and 696 COPD) presentations for exacerbation of asthma and COPD were reviewed. Although the majority of the patients were registered with a general practitioner (GP), less than 50% received medical attention from their GP and/or had an active intervention prior to presenting to hospital. These findings correlate with those found in the national review of asthma deaths. At a time of increasing demands on healthcare resources, these results pose the question of how we can better triage patients to appropriate care settings to minimise unscheduled care and improve patient outcomes.

Exploring the potential benefits of digital health technology for the management of COPD: a qualitative study of patient perceptions

“…Some studies have found the presence of consistently poor reporting behaviours among COPD patients, resulting in most exacerbations being unreported [55,56], while other work has highlighted that 50% of asthma and COPD patients were found not to receive GP intervention prior to presenting to hospital [57]. Therefore, early detection of exacerbations and prompt intervention is preferred as they have been shown to reduce recovery time, improve health-related quality of life and reduce the risk of hospitalisation [55].…”

A qualitative study of clinician perceptions regarding the potential role for digital health interventions for the management of COPD

“…Studies have shown COPD patients demonstrate consistently poor reporting of exacerbations, with 50% of patients failing to seek GP treatment before hospitalisation. [93][94][95] The potential for DHI to increase the disease knowledge of COPD patients is a promising area for future research, as it presents an opportunity to improve patient safety and reduce healthcare utilisation.…”

Obesity Does Not Increase the Risk of Asthma Readmissions

“…Similarly, they don´t have more frequent readmissions during the follow-up period. In the literature, asthma exacerbations requiring hospital admission are usually a minority, since most patients are discharged from the Emergency Room [14,65].…”