PAAP – Personalised Asthma Action Plans
To PAAP or not to PAAP, that is the question. I work in a busy GP practise helping patients with long term conditions. One of the long term conditions I specialise in is Asthma. Historically the UK has been poor compared to other European countries when it comes to supporting patients with Asthma, but I think things are changing. I think historically, QOF encouraged poor practice is asthma with reward provided to practices who asked the three RCGP questions.
The three questions are:
- Have you had difficulty sleeping because of your asthma symptoms (including cough)?
- Have you had your usual asthma symptoms during the day (e.g. cough, wheeze, chest tightness, or breathlessness)?
- Has your asthma interfered with your usual activities (e.g. housework, work, school)?
Tick tick, tick and away you go. However, too often, this apparent well-controlled asthma didn’t fit with other pieces of evidence like how many SABA inhalers were being issued in the previous 12 month period.
NRAD wake-up call
The National Review of Asthma Deaths published in 2014 highlighted overuse of SABAs as a strong indication of poor control, but it took until 2020/21 to make in as a QOF indicator. Other improvements include the need to look at inhaler technique, strong support for a personalised Asthma Action Plan and a more objective focus on more objective ways of diagnosing asthma.
Scan the QR code for a copy of the report
It’s all too easy for reviews to be rushed to keep on track with your list in a busy practice. We need to re-think our approach, and we need to start using the available resources to improve asthmatic patient’s better,
The first of the Key recommendations on the NRAD relating to medical and professional care was that all patients should have a personalised asthma action plan (PAAP.) However, Asthma UK found that 52% of asthmatic patients don’t have a PAAP. A PAAP is really useful, is done well and agreed with the patient. It gives patients the information they need to manage their asthma well and information about when they need to step up and step down treatments and when they need to call for help. So, in theory, PAAPs are great. My issue is that they could be better.
Link to Personalised Asthma Action plan on Asthma UK website https://www.asthma.org.uk/ccb4c070/globalassets/health-advice/resources/adults/asthmaactionplanadult-2021-final-editable.pdf
So in answer to the first sentence. We should PAAP, but we should PAAP more effectively.
PAAP 2.0
There are several potential problems with PAAPs:
- Has the PAAP been imposed on or agreed with the patient
- Does the patient have a peak flow metre to assess when they need to change their regime?
- Has the patient the confidence to follow the instructions?
- Does the patient have a pMDI SABA and spacer devise for emergencies – blue for the blue-light situation.
- Do the asthmatic patient and their family, know where their PAAP is?
In my opinion, the last issue is the biggest problem, but in theory, the easiest to fix. The printed off sheet probably gets put in a handbag or back-pocket after the appointment, and if we are lucky, then gets stored in a “safe” draw for later use when the patient gets home. We need the PAAP to be a living, breathing support document for a patient. Keeping the PAAP on a smartphone is a better option, so it’s always available – DROPBOX or Google Drive are options for document storage. Still, a dedicated, personalised APP would be much better. An app in which a patient could input Peak Expiratory Glow Rate (PEFR) readings and symptoms and then receive guidance on changes to the regime or prompts to seek help. Even better would be Smart Inhalers and Peak Flow metre that automatically upload information to an app and the GP clinical system.
Digitising the PAAP
Asthma UK document DIGITAL ASTHMA – Re-imaging Primary Care is a vision document that looks ahead to a world where asthma care is digitalized and is well worth a read. The vision is here; the smart inhalers are starting to arrive, and the need to there for all to see. Let’s make a PAAP a living, breathing support tool that allows asthmatic patients to make well-informed decisions about their own care and takes the UK from being one of the poorest countries for asthmatic patients of the best.
Medacy is excited about the potential to improve care for Asthma patients. I’m excited that Medacy is in the early stage of discussion to design and deliver truly innovative services to patients close to home. Our concept of a Medacy Clinical Hub is an ideal model for delivering innovative ways of working for patients. With other innovators, we aim to make asthma care the best in Europe.
Please contact Medacy if you would like more information
Contact Us page https://www.medacy.co.uk/medacy-clinical-services/
Phone 01677 252205
@medacyclinical
Email shaun@medacy.co.uk
