Health system characteristics and evidence-based asthma care

Alice L Crawford ^1,2 Gareth H Jones ³ Jane Scullion ⁴ Dermot Ryan ⁵ John Blakey ^1,2*

• ¹ Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
• ² Curtin Medical School, Curtin University, Perth, Australia
• ³ Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom
• ⁴ Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
• ⁵ Usher Institute, University of Edinburgh, Edinburgh, England, United Kingdom

Asthma is a common and complex syndrome, and a major cause of morbidity and healthcare costs. Clinicians have an array of evidence-based investigations and effective interventions at their disposal, but outcomes have not improved as much as trial evidence would suggest they could. This article discusses drivers behind this discrepancy using illustrative examples to highlight information gaps and barriers that impair the delivery of community and emergency asthma care and appropriate referral to specialist asthma services. It highlights organizational issues in the current system that lead to disjointed care that varies in quality. It also explores problems such as the adequacy of training for healthcare professionals, divergence from best practice guidance, and an acceptance amongst patients and practitioners of poor asthma control. This, along with inherent problems in the diagnosis of this heterogeneous disease, facilitates and perpetuates suboptimal care and outcomes. To help address the outcome gap, we discuss the potential for relatively simple, achievable and costeffective actions that could potentially be taken by clinicians together with commissioners and managers of healthcare systems.