Providing effective asthma care to people with learning disabilities

Introduction

Patients who have learning disabilities and long-term respiratory conditions are often seen in routine clinics that are not adapted to their individual needs. In the case of asthma, this can lead to poor asthma control and a reliance on emergency services (Brown, 2005).

The service challenge

We knew the 28 patients with learning disabilities attending our asthma service often accessed emergency services. They used the 111 service, ambulance, out-of-hours GP service, walk-in centres and the emergency department 116 times for asthma-related issues between September 2015 and January 2016.

Our regular asthma review clinics had 10-minute review appointments but we found that people needed up to 30 minutes with these patients to establish good communications and help them understand their asthma.

Redesigning the service

We set up a specialist asthma clinic for people with learning disabilities, to:

• Tailor asthma education and management to people with varying degrees of learning disabilities;
• Aid adherence to treatment;
• Manage asthma more effectively and improve quality of life;
• Reduce use of emergency services and avoid hospital admission.

In February 2016, we set up a weekly clinic with six 30-minute appointment slots. Here, patients have enough time to discuss any issues; we have time to reinforce adherence to medication regimens.

The clinic is staffed by a respiratory nurse specialist and a healthcare assistant, both of whom work in our chest clinic. This is an extra service within existing resources with no extra funding. The specialist nurse completes a full patient assessment, including asthma control, and an anxiety and depression score. The nurse also assesses each patient’s level of understanding and literacy skills and develops asthma management plans. The HCA helps the respiratory nurse, checks patients’ inhaler technique and reinforces self-management plans established during the visit.

To support patients, we have produced literature with help from Sunderland Action for Health, a local support agency for people with learning disabilities. This includes leaflets on asthma and how to manage an attack, as well as self-management plans in an easy-to-read format.

We are also in the process of providing a video link for inhaler techniques on our website, which is available to all patients and their carers.

Patient-friendly monitoring and adherence devices are used, including peak flow meters with colour alerts for patients with literacy difficulties and spacers with masks to aid inhaler technique for those with more severe LD.

Outcomes

The project has been running for 10 months, during which the number of times this group of patients accessed emergency care services dropped by 25%. It is difficult to determine whether this is due to improved adherence, improved education and understanding, or both.

Patients’ comments are positive:

“I understand now I might just be anxious and know what to do to try and tell whether it’s an asthma attack or anxiety.”

“I have never been able to know what my breathing reading [peak flow] was before and it helps me know. If it’s in the amber, like traffic lights, I need to get ready to do something.”

Future plans

Although the number of patients seen in the clinic is fairly low, these are high acute/emergency care users. We hope to also roll out this model of care to patients with LD and sleep apnoea.