Transcript Respiratory MURs

Areas to cover
 Analysis of information
 Recruitment
 Review
Key Areas For Analysis
 Inhaler technique
 Dosing regimens
 Compliance with regimen
 Overuse of SABA
 Over/underuse of combination inhalers
 Assessing patient knowledge
Key Areas For Analysis
 Management plans
 Target those DNA’s
 Is patient using correct inhaler?
 Assessing pts. for ‘step down’ therapy
 Switching COPD pts. from Seretide Evohaler to
Accuhaler if appropriate
Possible causes of poor control
 Adherence(Compliance)
 Education/understanding of condition
 Poor Inhaler Technique
 Medication issues
 Management issues
Methods
Check symptom control3 RCP questions??
- Have you difficulty sleeping because of your asthma
symptoms?
- Have you had you usual asthma symptoms during the
day?(cough, wheeze, tightness in chest or breathless)
- Has your asthma interfered with your usual activities?
(all Pts. with asthma over 16 years)
ACT Test
CAT Test
Knowledge
- Their knowledge of condition, treatment and
management
- Information you can give them
- CHECK THEY UNDERSTAND!!!
Understanding Asthma is not
enough
Facts, figures and overload of information is not
enough to reduce morbidity on its own.
Asthma education is not just about understanding the
condition .
The key issues are:- educating what to do
and
- when to do it
Visual
Practical
History
Improving Compliance!!!!
2 important aspects
Making Asthma/COPD more
fashionable!!
New devices!!!
 Elipta
 Genuair
 Dry powder devices
 Breezhaler
 Many more coming to market!!
Assess eaches position within context of
guidelines!!
Inhaler technique???
 150 professionals asked to demonstrate how to self admin a
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pMDi-doctors, nurses, hosp. and comm. staff.
74 –primary care 76 –secondary care.
Marked against standard checklist set by Manu. and Health
Ed.
113 (75%) of part. involved in teaching of inhaler technique.
Of these 113 – only 11!!!(9%) could demonstrate all the
recognised steps.
Small study whose results cannot be overstated but think
about checking your own technique.
Questioning
Side effects
 Oral thrush
 Sore throat/hoarseness
 Coughing
 Fast heart beats
 Taste
 Osteoporosis/Brittle bones risk (worse if smoker)
 Increase risk of cataracts in elderly?
Questions
Your concerns
Smoker?
Spacer use?
Information sharing?
Answer their queries
Guidelines
 BTS/SIGN
 When updating??
 What do they suggest? step up / down
 How/when to step down?
 Newer medications suggests need for review of
treatment options.
Both Asthma and COPD
Management Plans
Key issues addressed
 Active participation in the control and management
 Ability to recognise the signs and symptoms of
worsening asthma
 Ability to follow medication prescribed
 Ability to use inhaler devices correctly
 To identify any obstacles preventing compliance with
treatment plan
Training
 GSK
 Almirall
 AstraZeneca
 Cheisi
 Napp
 Asthma UK
 BTS/GINA guidelines
Conclusions/Outcomes
 Better understanding of what Asthma/COPD is and is
not
 Better understanding of importance of each inhaler
 Improved management understanding
 Poor inhaler technique corrected
 Is there a good time to ‘step down’
 Patients benefited from a more qualitative review
Going Forward…
 Quick reference guide
 Reassess each patient
 Be concerned for patients on high dose ICS
 Don’t forget ‘Step 2’
 COMPLIANCE
 EDUCATE
 QUESTION
 ‘Step down’ guidelines??
Getting the Basics right first
Patient in ‘control’ of Asthma
not it ‘controlling’ them!!!
Tips!!!
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If possible sit beside patient
Ask for honesty
Use positive body language
LISTEN
Explain slowly and with terms that they can
understand
Try not to over load with info, yet aim to improve
knowledge and understanding
Be confident!!!
Don’t be afraid to make recommendations
Reflect on ways forward
Thank you