Equality and health inequalities assessment (EHIA): GID-IND10339 MART (high risk patients)

What approaches have been used to identify potential equality and health inequalities issues during indicator development?

Checking equality impact assessment (EIA)/equality and health inequality impact assessment (EHIA) documents of the BTS/NICE/SIGN asthma guideline NG245, and other NICE asthma indicators.

Desktop searches during development of the indicator.

What potential equality and health inequalities issues have been identified during indicator development?

Socio-economic factors need to be considered (in particular those in the lower socio-economic groups). Reports from Asthma UK 2018 and Asthma + Lung UK 2023 found that people in lower socio-economic groups have higher rates of uncontrolled asthma and poorer outcomes, for example they are more likely to go to hospital for their asthma.

In the UK, people of South Asian origin with asthma experience excess morbidity, with hospitalisation rates three times those of the majority White population and evidence suggests that South Asian children with asthma are more likely to suffer uncontrolled symptoms and hospital admissions with acute asthma compared to White British children.

People with cognitive impairment, learning disabilities, language and communication difficulties, and mental health difficulties, may experience poorer outcomes.

How have the committee's considerations of equality and health inequalities issues identified in 1.2 been reflected in the indicator?

Populations noted in section 1.2 which have been identified as being at risk of poor outcomes will be specifically targeted by this indicator, which is designed to focus on MART in high-risk groups.

People with medication over-use or previous hospitalisation are more likely to be at greater risk of poor outcomes. A focus on improved medicines optimisation in this population aims to support better asthma control through individualised, patient-centred care.

Could any indicators potentially increase inequalities?

Indicators focusing on people most at risk of poor outcomes have the potential to decrease focus on those with less severe asthma. The existing indicator for annual reviews in the whole asthma population (IND273) will continue to be used. Annual reviews include an action plan, which incorporates information about medicines and what to do if asthma is worsening.

Based on the equality and health inequalities issues identified in 1.2 do you have representation from relevant stakeholder groups for the indicator consultation process, including groups who are known to be affected by these issues? If not, what plans are in place to ensure relevant stakeholders are represented and included?

Relevant stakeholders for the consultation include: Association of Respiratory Nurse Specialists, Asthma and Lung UK, Primary Care Pharmacists Association, Primary Care Respiratory Society UK, Rethink Mental Illness, Royal College of General Practitioners, Royal Pharmaceutical Society

Has it been proposed to exclude any population groups from coverage by the indicator? If yes, could these exclusions further impact on people affected by any equality and health inequalities issues identified?

The indicator does not include people with asthma who are not at risk of poor outcomes. Given that the focus of this additional indicator is on reducing health inequalities, this exclusion is justified.

Children aged 11 years and under have been excluded from this indicator because no asthma inhalers are currently licensed for MART in children under 12. Additionally, the BTS / NICE / SIGN asthma guideline (NG245) has 2 equal pathways after initial management for children aged 5 to 11 (MART pathway and conventional pathway) and an indicator focussing on MART could unduly influence the choice of pathway.

What questions will you ask at the stakeholder consultation about the impact of the indicator on equality and health inequalities?

Do you think there are any barriers to implementing the care described by these indicators? 

Do you think there are potential unintended consequences to implementing/ using any of these indicators? 

Do you think there is potential for differential impact (in respect of age, disability, gender and gender reassignment, pregnancy and maternity, race, religion or belief, and sexual orientation)? If so, please state whether this is adverse or positive and for which group. 

If you think any of these indicators may have an adverse impact in different groups in the community, can you suggest how the indicator might be delivered differently to different groups to reduce health inequalities?

A question will also be asked about the way that high risk groups are defined in the indicator.