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Wirral Health Commissing Corsortium Joint Working Case Study

Improving asthma outcomes in the Wirral Health Commissioning Consortium (WHCC): A 12-month re-audit

A Joint Working Case Study between WHCC and Teva UK Limited

Download the joint working case study

This is a case study of how Wirral Health Commissioning Consortium (WHCC) worked in a local joint working initiative with the Integrated Healthcare Manager from Teva UK Limited to improve asthma outcomes in registered practices.

Project rationale

According to the Practice Level Register as of the 1st April 2012, WHCC had 10,897 patients with a diagnosis of asthma. The average prevalence rate is 6.6% compared to a UK average of 5.6%. WHCC identified that over the last three years the annual average number of non-elective emergency admissions for WHCC was 255, with an approximate cost of £379,000.

WHCC wanted to explore innovations and best practice with the aim of improving asthma outcomes for patients registered to the WHCC practices.

This real-life case study compares the results of the baseline audit to the outcomes of the 12 month re-audit.

Desired Outcomes

The objectives of this joint working initiative were:

  1. To improve the clinical management and therefore the outcomes for patients over the age of 12 within participating practices of the WHCC division.
  2. To achieve a 10% reduction in non-elective admissions that would release cost savings of around £35,000.

Joint Working Initiative with Teva UK Limited

In order to achieve these outcomes, WHCC worked in collaboration with Teva UK Limited as they provided:

  • Project management and communication skills
  • Experience of delivering health audits with the NHS
  • A local Integrated Healthcare Manager and wider team to co-ordinate the initiative and bea source of contact for all stakeholders involved

Both the WHCC and Teva UK Limited abided by the relevant regulatory bodies and guidance, including the ABPI Code of Practice.

Approach defined

Audit methodology

Baseline audit:

  • Practices were sent a letter from WHCC informing them of the asthma project, inviting them to take part. Interested practices were then contacted by Teva UK Limited where an authorisation form was signed and agreement obtained for the audit to commence.
  • Respiratory Nurse Specialists employed by NSHI Limited and sponsored by Teva UK Limited in line with the ABPI Code of Practice for the Pharmaceutical Industry 2012 carried out baseline audits. NSHI Ltd has undertaken audits successfully in other PCTs and all services are delivered in line with the Data Protection Act 1998 and related healthcare legislation. The NSHI nurses had no involvement
    in the educational or clinical mentorship aspect of the project.
  • Data was extracted from the GP computer systems using MIQUEST. The quality of the audit was dependent on the quality and completeness of the practice clinical data.

12 month re-audit:

  • Practices were re-contacted and signed authorisation was obtained to allow the Respiratory Nurse Specialists undertaking the re-audit, employed by NSHI Ltd to return to the practice to re-run searches and gather 12 month comparative data in line with project requirements and 14 practices were involved in the re-audit.
  • Data was extracted from the GP computer systems using MIQUEST. The quality of the audit was dependent on the quality andcompleteness of the practice clinical data.

Practice Information

In WHCC, from the 14 practices included in the re-audit, the prevalence of asthma was 7.10% compared to 6.67% prevalence at the time of the original audit.

Outcomes achieved

(a) Reduction in hospital admissions and associated costs

  • According to available hospital data reports there was a reduction of 48% in hospital admissions, in practices where re-audit took place, compared to a 28% reduction in practices that did not take part
  • Again, utilising the available hospital data reports, this equated to a reduction in costs for hospital admissions in practices where re-audit took place of £59,137.68 (26%) exceeding the original objective

  • In the majority of practices, READ coding of hospital admissions had improved.

(b) Total costs for WHCC inpatient admissions for asthma

(c) Other patient outcomes observed

  • 2% increase (125 patients) in patients attending an annual asthma review at re-audit
  • 19% increase (732 patients) in patients who had an inhaler check performed at re-audit
  • 35% reduction (150 patients) in patients with uncontrolled asthma, using >6 short acting bronchodilators in a 12 month period as a proxy measure of control

(d) Positive feedback from practice nurses

Benefits of Joint Working with Teva UK Limited

This project demonstrated a successful collaborative approach to address a significant issue facing the local health economy.

Joint working between Teva UK Limited and the NHS must be for the benefit of patients or the NHS and preserve patient care1

1. Department of Health. Best practice guidance for joint working between the NHS and the pharmaceutical industry, 1 February 2008