Assessing variation in severe asthma care in England: a national benchmarking study

Abstract

Background: To improve access to Severe asthma (SA) services across England, an understanding of variation in delivery models is critical.

Aim: This study aimed to assess variation in SA care across primary care (PC), secondary care (SC) and tertiary care (TC) in England.

Methods: Organisations involved in SA care in England were invited to join this benchmarking study. Semi-structured interviews were conducted with respondents between March and May 2021. Responses were analysed using quantitative and thematic analysis techniques.

Results: 220 different organisations in England responded across different care settings. 3 key areas of variation emerged as most significant.

Patient Identification: Processes for identification of uncontrolled asthma in PC were varied. Most reported were reactive, with only 18% of respondents proactively seeking at-risk patients. Over 50% of PC respondents reported not having received training around SA.

Clinical Staff Resource: 68% of TC respondents reported clinical staffing limitations as the most significant barrier to service improvement. Over 30% of TC respondents reported having no designated adherence lead and 48% reported poor access to essential psychology support.

Pathway capacity: 36% of TC respondents reported other capacity challenges limited by: infrastructure (physical space available for clinics and testing); access to administrative support and technology to improve data flows.

Conclusion: Significant variation was observed in several areas of service provision. This work highlights an opportunity to rethink pathways and services for SA patients to address unwanted variation and to improve access to SA care.