3 Assess the current context

Contributors to this resource shared their learning and experiences on approaches to assessing local readiness for implementation. They advised on how evidence and data can be used to help plan how the asthma diagnosis recommendations can be incorporated into practice.

Demand

It is important to understand the demand on the service from people presenting with suspected asthma. Extracting the number of patients previously coded as 'suspected asthma' would indicate demand. However, sites in the feasibility project found that historically this code had not been consistently used. They therefore struggled to identify accurately, how many people had presented with suspected asthma. Contributors to this resource suggested several methods to estimate this:

  • scanning IT system for codes including suspected asthma and symptoms of asthma

  • checking prescribing data for new prescriptions of inhaled corticosteroids and inhaled bronchodilators (short-acting beta-agonists)

  • using the PRIMIS asthma tool

  • using NHS RightCare Intelligence

  • comparing the percentage of all practice patients diagnosed with asthma with national incidences (from the Asthma UK data portal) to give a national context to local diagnosis rates.

It was easier for sites to identify people diagnosed with asthma (incidences of asthma) because this was reported as a diagnosis on the GP system. Although lack of consistency in coding was also an issue.

To help map the data to the recommendations, the results can be grouped by the ages used in the recommendations (under 5, 5 to 16 years and 17 and over).

Map current pathway

To identify the changes needed, it is critical that services understand the current care pathway for diagnosis of people presenting with suspected asthma by mapping the care pathway. Discuss the current practice with all healthcare professionals involved in assessing people with suspected asthma. Feasibility project sites found variation both between practices and among healthcare professionals in the same practice.

Sites reported that supplementing this verbal information from colleagues with baseline quantitative data from recorded practice episodes helped gain a greater understanding of current practice. Consider using local IT systems to collect some or all of the following information about people presenting with suspected asthma:

  • the amount of time and number of appointments (with all healthcare professionals) from first presentation to diagnosis of asthma or another condition

  • whether any objective tests were used in the diagnostic process

  • who did the assessment or tests

  • who made the diagnosis.

Equipment needed

Review the equipment currently available for asthma diagnosis, including:

  • current availability and location of spirometry, fractional exhaled nitric oxide (FeNO) and peak flow devices

  • anything that may compromise the current availability of these devices, for example if any need replacing or are at the end of their warranty period

  • the current demand for these devices for diagnosing asthma or other respiratory conditions.

Competency in objective testing

Spirometry (including bronchodilator reversibility)

Check who in the practice or locality is competent in the recognised standards (see the section on training in doing and interpreting spirometry).

FeNO

Check how many people within the practice or locality have received training to carry out FeNO testing and interpret results competently. Assess whether more people will need training (see the section on training).


This page was last updated: 22 February 2018