Novel models of asthma care in UK General Practice

: lessons from the COVID-19 pandemic

Abstract

Background
From the start of the COVID-19 pandemic General Practice has been under considerable pressure to maintain services despite pandemic restrictions including social distancing measures, adjusting to remote consulting and coping with rising workload. Ongoing provision of asthma care has been particularly challenging due to the overlap between COVID-19 and asthma symptoms, uncertainty about the additional risk posed by the virus risk to this patient group, and the challenges of delivering vital elements of an asthma consultation within COVID-19 restrictions.

Study 1
Searches of routinely collected primary care records to identify patients with severe asthma for shielding during the COVID-19 pandemic has highlighted the challenges of accurately identifying this high-risk cohort from routinely collected data. However, it also placed a spotlight on exciting potential opportunities including identifying people who could benefit from specialist assessment. Study 1 aimed to determine how previous studies have used primary care records to identify and investigate severe asthma and whether linkage to other data sources is required to fully investigate this ‘high-risk’ disease variant.
A scoping review was conducted based on the Arksey and O’Malley framework. Twelve studies met all criteria for inclusion. We identified variation in how studies defined the background asthma cohort, asthma severity, control and clinical outcomes. Certain asthma outcomes including hospitalisations could only be investigated through linkage to secondary care records. This study highlighted the unique capacity of primary care data to identify people with severe asthma, particularly in the UK. However, a number of challenges need to be overcome if its full potential is to be realised.

Study 2
The COVID-19 pandemic led to the rapid and reactive deployment of remote consulting in UK General Practice. Study 2 aimed to explore the implementation of remote consulting for asthma in UK General Practice in response to the pandemic.
I conducted a mixed-methods evaluation of the implementation of remote asthma consulting in General Practice in Northern Ireland, informed by extended normalisation process theory. Ten themes were identified to describe and explain the contribution of General Practice staff to implementation of remote asthma consulting. Staff identified novel alternatives to deliver the components of an asthma consultation remotely. Practice champion were important to drive implementation forward, and engage other members of staff. Patient, staff, and healthcare system-contextual factors influencing implementation were identified including access to, understanding of, and willingness to use the technology required for remote consulting. This study demonstrated that remote consulting could be integrated into asthma care in General Practice. However, work is required to develop an approach which ensures patient access is not negatively affected, and ensure practices have the required capability and capacity for implementation.

Conclusion
The two complementary studies in this thesis demonstrate that lessons can be learned from the COVID-19 pandemic to inform asthma care delivery in General Practice in the future. Building on the findings of the two studies and other research, I propose a personalised model to demonstrate that a new approach to asthma care in General Practice could be developed. Time will tell whether we choose to learn from the pandemic to enhance the care we provide to patients with asthma.

Date of Award	Dec 2022
Original language	English
Awarding Institution	Queen's University Belfast
Supervisor	Frank Kee (Supervisor), Nigel Hart (Supervisor) & Liam Heaney (Supervisor)