Thursday 20 th September 2012 The Copthorne Hotel NHS Dudley & - - PowerPoint PPT Presentation

The Copthorne Hotel Thursday 20th September 2012

NHS Dudley & GlaxoSmithKline ‘Excellence in Asthma’ Project July 2011 - June 2012

Dr Mark Hopkin GP & Clinical Lead

Excellence in Asthma - Background

Commitment & Clinical Engagement of Practices in Respiratory already existed. The aim of this project was to improve the quality of asthma care across practices in Dudley by providing education. Practices were encouraged to aspire to a High Standard of Care which was defined by the Dudley ‘Excellence in Asthma’ Award. This required seven criteria to be met:

Excellence in Asthma

• 1. Practice will have a named Asthma GP & Nurse Lead
• 2. Named Asthma GP & Nurse will attend a 3 hour training

session

• 3. To provide a Structured Asthma Review using READ codes

provided

• 4. Record BTS Step of asthma
• 5. The practice will use the DRG Self Management Plans
• 6. The practice will conduct 20 adult & 5 children's Patient

Satisfaction Questionnaires

• 7. Asthma Nurse and GP will complete a HCP questionnaire

Excellence in Asthma

• The Project Steering Group had representation from Primary Care,

Commissioning, Provider, Medicines Management and GlaxoSmithKline

• All Dudley GP Practices were invited to participate in the Asthma In

Excellence Project

• The project started in July 2011 and completed end of June 2012

‘Sign Up’

• All Dudley GP Practices signed

up to the project (100%)

Support Materials

• Dudley Asthma Treatment Guidelines
• Dudley Asthma Action Plans
• Structured Review – READ codes

Support Materials – cont’d

• Inhaler Boxes & Devices
• Dudley Respiratory Group Website

www.dudleyrespiratorygroup.org

Evaluation of the Project

• The success of the project was evaluated by:

– A patient satisfaction questionnaire to assess patients’ perceptions of their care and disease understanding following their annual asthma review. – A questionnaire of Healthcare Professionals to assess the impact of the education. – Engagement and Sign up of practices to the project – Attendance at the Training Days – Partnership working with Pharmaceutical Industry

• The potential impact of the project upon longer term

measures such as hospital admissions data can be assessed fully in due course.

‘Excellence in Asthma’ Evaluation

Joanne Hamilton Lead Nurse - Respiratory

Excellence in Asthma

• 7 Training Sessions June 2011 – March 2012
• Different Locations
• 130 Health Care Professionals attended
• 3 hour session including paediatric and adult

asthma management

• As a consequence of these sessions

3 in house one day training sessions - 38 HCPs Asthma Diploma – 20 HCPs

Health Care Professional Survey

Evaluation of the Dudley Excellence in Asthma education programme September 2012

Did our education upskill Healthcare Professionals?

Methodology

• A paper based questionnaire given to healthcare professionals at

the end of the asthma in excellence project

• The Lead GP & Lead Nurse were asked to complete the

questionnaire.

• Questionnaires were returned by Fax or Courier to a designated

address

Health Care Professional Evaluation Questionnaire – Overview of respondents

• 75 respondents

– Including 52% Practice Nurses, 39% GPs.

• 43% had no previous accredited asthma training.
• 85% run an Asthma clinic within their practice.

How valuable has the education been improving HCPs’ understanding of core knowledge?

Thinking about the education that you have received... how valuable has it been in improving your understanding of........ Not at all valuable Of limited value Valuable Extremely valuable How to diagnose children’s asthma 0% 9% 62% 29% Optimum prescribing for children with asthma 0% 9% 58% 33% How to manage acute asthma in children 0% 10% 60% 30% Dudley local guidelines on the management

• f asthma

0% 1% 52% 47% How to classify patients according to BTS/SIGN steps 0% 7% 57% 36% The importance of inhaler technique 0% 5% 48% 47% The importance of compliance 0% 8% 45% 47% How to provide a structured asthma review 0% 7% 47% 47%

• 95% found the education valuable/extremely valuable on inhaler technique
• 92% found the education valuable/extremely valuable on how to provide a structured

review.

Following the education ....knowledge of diagnosing children’s asthma has improved significantly

On a scale of 1 to 10 how to knowledgeable were you before and after the education in diagnosing children’s asthma. 1= Not knowledgeable at all; 10=extremely knowledgeable. Total Respondents = 73

3% 3% 5% 7% 19% 19% 11% 21% 5% 7% 0% 0% 0% 0% 3% 3% 14% 43% 25% 13%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 1 2 3 4 5 6 7 8 9 10 Before After

4% 4% 7% 8% 22% 18% 14% 14% 4% 7% 0% 0% 0% 0% 7% 12% 11% 38% 20% 12%

0% 5% 10% 15% 20% 25% 30% 35% 40% 1 2 3 4 5 6 7 8 9 10 Before After On a scale of 1 to 10, how to knowledgeable were you before and after the education in

• ptimum prescribing for children with asthma.

1= Not knowledgeable at all; 10=extremely knowledgeable. Total Respondents = 74

following the education ... knowledge of optimum prescribing in children’s asthma has improved significantly.

3% 1% 3% 8% 15% 12% 13% 28% 11% 7% 0% 0% 0% 0% 3% 1% 11% 39% 25% 21%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 1 2 3 4 5 6 7 8 9 10 Before After On a scale of 1 to 10, how to knowledgeable were you before and after the education in how to mange acute asthma. 1= Not knowledgeable at all; 10=extremely knowledgeable. Total Respondents = 75

Following the education ....knowledge of how to manage acute asthma has improved significantly

Knowledge of the Dudley local guidelines has improved significantly

3% 1% 5% 13% 15% 20% 13% 13% 9% 7% 0% 0% 0% 0% 0% 4% 5% 36% 32% 23%

0% 5% 10% 15% 20% 25% 30% 35% 40% 1 2 3 4 5 6 7 8 9 10 Before After On a scale of 1 to 10, how to knowledgeable were you before and after the education of the Dudley Asthma Respiratory Guidelines. 1= Not knowledgeable at all; 10=extremely knowledgeable. Total Respondents = 75

Knowledge of how to classify patients according to BTS/SIGN steps has improved

3% 1% 5% 4% 21% 13% 11% 21% 12% 8% 0% 0% 0% 0% 1% 4% 7% 28% 39% 21%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 1 2 3 4 5 6 7 8 9 10 Before After On a scale of 1 to 10, how to knowledgeable were you before and after the education in classifying patients according to BTS/SIGN steps. 1= Not knowledgeable at all; 10=extremely knowledgeable. Total Respondents = 75

Knowledge of the importance of inhaler technique has improved

1% 0% 3% 4% 12% 5% 11% 22% 15% 27% 0% 0% 0% 0% 3% 3% 3% 16% 28% 47%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 1 2 3 4 5 6 7 8 9 10 Before After On a scale of 1 to 10, how to knowledgeable were you before and after the education around the importance of inhaler technique. 1= Not knowledgeable at all; 10=extremely knowledgeable. Total no of Respondents = 74

Knowledge of the importance of compliance in asthma has improved

1% 0% 1% 3% 7% 7% 9% 19% 22% 31% 0% 0% 0% 0% 3% 0% 4% 15% 31% 47%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 1 2 3 4 5 6 7 8 9 10 Before After On a scale of 1 to 10, how to knowledgeable were you before and after the education around the importance of compliance in asthma. 1= Not knowledgeable at all; 10=extremely knowledgeable. Total Respondents = 74

Knowledge of how to provide a structured asthma review has improved

3% 0% 5% 8% 3% 16% 12% 19% 21% 12% 0% 0% 0% 0% 0% 0% 5% 22% 33% 40%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 1 2 3 4 5 6 7 8 9 10 Before After On a scale of 1 to 10, how to knowledgeable were you before and after the education around how to provide a structured asthma review. 1= Not knowledgeable at all; 10=extremely knowledgeable. Total Respondents = 73

What impact has the education had upon behaviour within a ‘typical’ asthma review?.

Which of the following is part of a ‘typical’ asthma review that you now conduct for patients? I rarely/never do this Yes, as a result

• f the Asthma

training Yes, I always have done this A structured asthma review based upon the READ codes provided by Dudley Respiratory Group 4% 61% 35% Completion of the 5 ‘Asthma Control Test’ (ACT) questions 4%

76%

20% Assessment of which BTS/SIGN asthma ‘step’ a patient is currently on 1%

62%

36% Review of a patients asthma medication 0% 22% 78% Review of a patient inhaler technique 0% 24% 76% Smoking cessation advice 0% 13% 87% The Dudley Asthma Action Plan (self management plan) 0%

74%

26% Flu vaccinations 0% 10% 90%

• As a direct result of the education, 76% of HCPs are now using the asthma control

test (ACT) to assess asthma control as part of ‘typical’ reviews, and

• 74% are now using self management plans.

What impact has the education had upon behaviour asthma management?

As a result of your practice participating in the Excellence In Asthma program, to what extent do you agree with the following? Strongly disagree Disagree Agree Strongly agree Patients receive a more effective asthma review. 1% 4% 69% 26% We have a greater understanding of patients levels of asthma control 1% 1% 70% 27% We have a greater understanding of patients use

• f their inhalers

1% 7% 68% 24% We have improved our management of patients medication in line with national guidelines 1% 4% 66% 29% On leaving their review appointment, patients are better placed to manage their asthma 1% 4% 67% 27%

• As a direct result of the education, 95% of HCPs believe that patients are receiving

more effective asthma reviews; and

• 95% believe patients are better placed to manage their asthma.

Has the education improved HCPs’ view of the quality

• f asthma review they give patients?

0% 0% 0% 9% 6% 26% 19% 29% 6% 7% 0% 0% 0% 0% 0% 0% 4% 25% 41% 30%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 1 2 3 4 5 6 7 8 9 10 Before After How would you rate the overall quality of the typical asthma review you conducted before the education, and the asthma review you conduct now. 1= Poor; 10=Excellent. Total Respondents = 71

The length of a typical asthma review is now 5 minutes longer following the education program

• The average length of a ‘typical’ asthma review appointment

– Before the education: 17minutes. – After the education: 22minutes.

• On average, HCPs reported that they believed the optimum

length of an asthma patient review is 23minutes.

Patient Experience Questionnaire Results

Evaluation of the Dudley Excellence in Asthma education programme September 2012

Patient Experience Questionnaire – Overview of respondents

• 258 Respondents (Male 95 & Female 154)
• Replies returned in a Freepost Envelope to DGH Foundation Office
• The average age was 52 years (range 18-65)
• 95% were from a White background
• 80% had been diagnosed with asthma for more than 5 years
• 93% of the asthma reviews were completed by an Asthma Nurse
• Average asthma review lasted 19.5 minutes

Patients reported high levels of valuable information imparted by HCPs within their asthma reviews.

In the asthma review you have just had..... Yes No Don’t Know

Was it explained to you how asthma may affect you? 92% 6% 2% Was it explained what to do if your symptoms improve or get worse? 96% 4% 0% Were you shown how to use your inhaler 93% 7% 0% Was it explained to you how your medicine(s) / inhalers benefit you? 91% 8% 1%

84% of patients were given a self management plan to help them look after their asthma

Providing Self Management education and a written action plan may reduce hospital re admissions and improve symptom control and self management of asthma. ( Bernard – Bonnin et al, 1995; Nathan et al, 2006 Total Respondents = 249; ‘Yes’ = 209; ‘No’ = 36; ‘Don’t Know’ = 4.

83.94% 14.46% 1.61% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% YES NO DON'T KNOW

The majority of patients were asked to complete a short questionnaire about their asthma symptoms to help assess levels of asthma control and

• ptimise management. (Asthma Control Test)

Total Respondents = 233; ‘Yes’ = 165; ‘No’ = 57; ‘Don’t Know’ = 11.

70.82% 24.46% 4.72% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% YES NO DON'T KNOW

Although 80% of patients had been diagnosed with asthma for more than 5 years, a notable increase in reported levels of understanding of asthma was

• bserved following their review.

1% 2% 1% 3% 10% 9% 8% 17% 13% 36% 0% 0% 0% 0% 2% 2% 4% 15% 21% 55% 0% 10% 20% 30% 40% 50% 60% 1 2 3 4 5 6 7 8 9 10 Before After

Total Respondents = 255. Qn: On a scale of 1 to 10, how would you rate your overall understanding of your asthma ? Before and after your latest asthma review.

1% 2% 43% 30% 24% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% DECREASED A LOT DECREASED A LITTLE STAYED THE SAME INCREASED A LITTLE INCREASED A LOT

54% of patients reported an increase in their understanding of how asthma affects them as a result of their latest review appointment.

“Qn: My understanding of how asthma affects me has...” Total Respondents = 250; ‘Decreased a Lot’ = 2; ‘Decreased a Little ’ = 4; ‘Stayed The Same’ = 107; ‘Increased A Little ‘ = 76; ‘Increased A Lot = 61.

0% 1% 40% 27% 32% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% DECREASED A LOT DECREASED A LITTLE STAYED THE SAME INCREASED A LITTLE INCREASED A LOT

59% of patients reported an increase in their understanding of

when to use their asthma inhaler(s) as a result of their latest

review appointment.

“Qn: My understanding of when to use my inhaler(s) has...” Total Respondents = 250; ‘Decreased a Lot’ = 1; ‘Decreased a Little ’ = 2; ‘Stayed The Same’ = 101; ‘Increased A Little ‘ = 67; ‘Increased A Lot = 79.

0% 0% 44% 26% 29% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% DECREASED A LOT DECREASED A LITTLE STAYED THE SAME INCREASED A LITTLE INCREASED A LOT

55% of patients reported an increase in their understanding of how to take their asthma inhalers.

Qn: “My knowledge of how to take my inhaler(s) has...” Total Respondents = 250; ‘Decreased a Lot’ = 1; ‘Decreased a Little ’ = 0; ‘Stayed The Same’ = 110; ‘Increased A Little ‘ = 66; ‘Increased A Lot = 73.

1% 1% 45% 25% 28% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% DECREASED A LOT DECREASED A LITTLE STAYED THE SAME INCREASED A LITTLE INCREASED A LOT

53% of patients reported that their understanding of how their inhaler(s) work in their lungs has improved.

Qn: My understanding of how my inhalers work in my lungs has.... Total Respondents = 250; ‘Decreased a Lot’ = 3; ‘Decreased a Little ’ = 3; ‘Stayed The Same’ = 113; ‘Increased A Little ‘ = 62; ‘Increased A Lot = 69.

0% 1% 31% 30% 37% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% DECREASED A LOT DECREASED A LITTLE STAYED THE SAME INCREASED A LITTLE INCREASED A LOT

67% of patients reported increased knowledge of what to do if their symptoms get better or worse.

Qn:”My Knowledge of what to do if my symptoms get better or worse has...” Total Respondents = 251; ‘Decreased a Lot’ = 0; ‘Decreased a Little ’ = 2; ‘Stayed The Same’ = 79; ‘Increased A Little ‘ = 76; ‘Increased A Lot = 94.

Patients reported positive views on the manner with which their asthma review was conducted.

To what extent do you agree or disagree with the following questions Disagree strongly Tend to disagree Tend to Agree Agree Strongly The asthma review was thorough enough for me 1% 1% 37% 61% I was involved as much as I wanted to be in decisions about my care and treatment 1% 1% 40% 58% I was treated respectfully throughout my asthma review 0% 0% 21% 79% I was able to ask all of my questions during my asthma review 0% 0% 27% 73% I felt that my questions were clearly answered during my asthma review 0% 1% 24% 75%

2% 0% 14% 84% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% VERY DISSATISFIED FAIRLY DISSATASFIED FAIRLY SATISFIED VERY SATISFIED

Patients were overall very satisfied with their asthma reviews.

“Qn: Overall how satisfied were you with the asthma review?” Total Respondents = 249; ‘Very Dissatisfied’ = 5; ‘Fairly Dissatisfied ’ = 1; ‘Fairly Satisfied ’ = 34; ‘Very Satisfied’ = 209.

Admission Data July 2011 – June 2012

Andrew Hindle Commissioning Manager -CCG

Moving Forward

• 2012 /13
• Continue to support practices with education and

materials

• Asthma Diploma - Education for Health
• Continue to implement and embed Management of

Acute Asthma & 48 hour follow up ‘Top Service User’ events for children's asthma

• 2013/14

Monitor use of Short acting beta agonists