Viewpoint: Reducing DNAs for asthma reviews will save lives

Asthma UK has produced a new guide to help practices reduce the number of patients failing to attend asthma reviews. The simple steps can make a big difference, says Dr Kris McLaughlin.

Some people may have been shocked by the news last month that Stuart Baggs’, of The Apprentice fame, died from an asthma attack at just 27 years of age.

Tragically his death is proof that asthma still kills. In fact, three people die from asthma attacks every day in the UK and every 10 seconds someone is having a potentially life threatening attack.

As clinicians we want to ensure that people with asthma are receiving the care they need to manage their asthma effectively. But we can only do this if patients actually attend their annual asthma review and other key appointments.

As GPs working in primary care, we are only too aware of the challenge laid bare by The National Review of Asthma Deaths, which showed that two thirds of asthma deaths may be preventable with better routine care.

1m missed asthma appointments

Although the asthma review is the bedrock of asthma care, where treatment is adjusted as necessary to fit the changing nature of the condition over time, last year 1m people with asthma missed their annual  review appointment.

‘Did not attends’ are one of the biggest sources of frustration when I talk to fellow clinicians. Many of us are working longer hours than ever before, and experiencing an increasing sense of frustration that people we know we could help are not engaging with our services and wasting appointments in the process.

The cost of an emergency admission is on average 23 times the cost of an annual asthma review and the UK still has one of the highest prevalence rates for childhood asthma in Europe1 (and some of the highest asthma hospital admission and death rates in Western Europe). Therefore, it is clear that getting more patients attending reviews will improve asthma care and save lives, time and money. 

It will also reduce the intense frustration felt by those of us who work incredibly hard to encourage patients to attend their reveiws and take more interest in their self-management.

New guidance to reduce DNAs

It is with some optimism then, that I have had the opportunity to contribute to an Asthma UK initiative to identify proven, practical tips to reduce DNAs and encourage patients to be better prepared for their asthma reviews.

In my surgery I offer telephone reviews for those patients with mild or well controlled asthma (this is especially useful in rural areas and working populations). This can also be useful for patients who have not attended appointments and may not be aware that their asthma control is poor.

Some 86% of GPs recently surveyed by the BMA agree that phone consultations can be effective, and asking the three RCP asthma control questions over the phone counts towards the QOF.

These, and other tips to increase patient attendance and the effectiveness of consultations, are featured in the Asthma UK guidance which is written for busy GPs and other professionals working in primary care.

There are some great resources too, such as motivational templates for missed appointment letters. Other simple but effective ideas include asking patients to video symptomatic episodes on their smart phones and show you the footage. This can be more efficient than asking patients to describe their symptoms during the consultation, especially if language barriers or low levels of health literacy exist.

Putting up posters focusing on positive attendance rates rather than negative ones has also been shown to make a difference. Even adjusting invitation letters to be more motivational and clear about how a patient needs to prepare can reap rewards. Evidence shows these easily-implementable tips can reduce DNAs, in some case by more than a third.

In the relentless world of today’s practice it can be all too easy to feel frustrated by a seeming lack of engagement from patients, and a total lack of time to simply share and implement best practice ideas with colleagues. But simple adjustments to our services can make things more efficient – and less frustrating – for us all.

To get more easy to implement and effective ideas in this vein, you can download the Asthma UK guidance below. Tweet Asthma UK with your feedback on the tips you rate most highly @asthmauk

Download Asthma UK's 10 tips to reduce DNAs and improve efficiency in your practice

  • Dr Kris McLaughlin is a GP in Stonehaven, Aberdeenshire and a member of Asthma UK’s Council of Healthcare Professionals.

1. According to the Death rates (all ages) for OECD nations and the World Health Organisation

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