The End to End Model of Care for Asthma – what it means for general practice

MS RUTH MORROW, Registered Advanced Nurse Practitioner (Primary Care); Respiratory Nurse Specialist (WhatsApp Messaging Service Asthma Society of Ireland); and Nurse Educator and Consultant 

The HSE’s new End to End Model of Care document for adult asthma outlines the structures that healthcare professionals should adhere to and adopt in the care of patients with, or at risk of, asthma

Asthma is the most common chronic respiratory disease in Ireland, with approximately one-in-10 of the population having asthma. Asthma control remains suboptimal in a large proportion of patients, which places significant health, social, and economic burden on the community and on healthcare. The reasons why asthma control remains poor is multi-factorial, but fragmented and unstructured care is believed to be an important contributory factor. The cost of asthma care in Ireland is over €500 million per annum, most of which is in secondary care. 

The HSE’s new End to End Model of Care (MOC) for Asthma has been developed in consultation with a wide range of stakeholders including nurses, consultants, GPs, physiotherapists, patients, and patient support organisations. It covers the full spectrum of care provided in both hospital and in the community with a focus on developing partnerships between acute hospital services, general practice and community services, with the patient and his/her family being central to the model. 

The End to End MOC for adult asthma has been developed in tandem with the HSE strategy for chronic disease. It outlines the structures that we should adhere to and adopt in the care of patients with, or at risk of, asthma. This MOC is guided by national and international best practice. 

The document is not meant to be a guideline document outlining interventions to be used in varied clinical circumstances that present when managing patients with asthma. In this regard the National Clinical Care Programme (NCP) Respiratory endorses the guidelines produced and updated regularly by the Irish Thoracic Society (ITS), the ICGP, and Global Initiative for Asthma (GINA). However, the MOC document details how patients should be able to access care at various stages of their asthma and also outlines the roles and responsibilities of the healthcare professionals (HCPs) providing this healthcare. It is envisaged that the implementation of this MOC will result in a reduction in the variation of care delivered to patients with asthma in Ireland and additionally result in an improvement in their asthma control, clinical outcomes and quality-of-life. 

The MOC seeks, through the implementation of its guidelines, to improve the standard of care provided to adult asthma patients in all healthcare settings, with a particular focus on primary care where the majority of asthma is managed. This MOC will place a particular focus on the ‘at-risk’ patients who are vulnerable to developing asthma and those at risk of experiencing an acute asthma event. This includes those in lower socio-economic groups, smokers, patients with multiple co-morbidities, and those with psychological problems. 

This document details how patients should be able to access care at various stages of their asthma, and also the roles and responsibilities of the healthc

The MOC is a guide for best practice in the care of those at risk of developing asthma as well as those diagnosed with the condition across the continuum of care and includes both acute and chronic management of asthma in primary, secondary, and tertiary care settings. 

The implementation of the MOC aims to ensure that optimum care is delivered using the principles of Sláintecare; so people with asthma receive the right care at the right time in the right place. 

The spectrum of services, ranging from primary prevention to tertiary care, includes: 

• Primary prevention and health promotion. 
• Risk factor identification and management. 
• Early detection of asthma and its diagnosis. 
• Secondary prevention. 
• Primary care management of asthma. 
• Shared primary and secondary care management of asthma. 
• Secondary care management of chronic asthma. 
• Tertiary care. 
• The aims of the NCP for Respiratory specific to adult asthma are: 
• Maximise health and quality-of-life of people with asthma. 
• Minimise future risk for patients. 
• Prevent avoidable mortality due to asthma. 
• Standardisation of care for asthma patients in Ireland. 
• The objectives of the NCP for Respiratory include: 
• To improve access to structured integrated asthma care for patients diagnosed with asthma, which will address asthma education in the most appropriate setting. 
• To facilitate the provision of guideline concordant care, based upon a patient’s level of asthma control. 
• To maximise the proportion of patients with asthma whose asthma is controlled. 
• To identify the appropriate resources needed to deliver on the aims of the NCP for Respiratory in relation to asthma. 

In addition to guiding the delivery of the aforementioned objectives, this End to End MOC for adult asthma reflects the key reform themes identified by the HSE to improve the health of the population and to reshape where and how healthcare services are provided in Ireland. These themes include improving population health, delivering care closer to home, developing specialist hospital care networks, and improving quality, safety, and value. 

MOC scope 

The scope of this MOC is to define the services required to support the general population of adults in the management of their asthma. It includes health services operated and funded by the HSE and includes community-based services as well as access to hospital-based secondary and tertiary care services if required. It acknowledges that specific health and social care settings, high-risk and vulnerable groups will require additional interventions and support. Working with other relevant national clinical programmes (paediatric and neonatal) and services, this MOC will inform the future development of shared pathways, policies, strategies and services to improve health outcomes in these settings. Supporting documents include clinical guidelines published by the ICGP, ie, Asthma – Diagnosis, Assessment, and Management in General Practice Quick Reference Guide. The National Clinical Guideline for the Management of an Acute Asthma Attack in Adults (NCEC) is also referred to in this document. International clinical guidelines, such as those from GINA (2021), underpin the diagnosis and management of asthma. 

Future development includes the NCP Respiratory collaborating with NCP Paediatrics and Neonatal to form a paediatric working group to develop Part 2: Paediatric Asthma. 

Download the End to End MOC at: www.hse.ie/eng/about/who/cspd/ncps/asthma/resources/end-to-end-model-of-care-for-asthma.pdf for more information.