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      Best practices for interdisciplinary care of uncontrolled severe asthma patients (TEAM project) Translated title: Buenas prácticas de trabajo en equipos multidisciplinares para la atención al paciente con asma grave no controlada (Proyecto TEAM)

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          Abstract

          Abstract As one of the most prevalent chronic respiratory diseases, asthma imposes a heavy health and socioeconomic burden on society, particularly in the case of patients who fail to appropriately control the disease. For this reason, improving the clinical management of patients with severe uncontrolled asthma should be a priority for any healthcare system. At a time when healthcare models for chronic disease management and personalized medicine are undergoing a major overhaul, the project presented in this study seeks to lay the foundations for an interdisciplinary care model for patients with severe uncontrolled asthma. The work carried out reinforces the general perception that it is paramount to optimize coordination between different levels of care, encourage collaboration and an interdisciplinary approach, and promote an integrated care model that makes it possible to adapt the care of patients with severe uncontrolled asthma in a more personalized manner. Under this project, a series of interdisciplinary working groups were created, made up of specialist hospital pharmacists, pneumologists and allergists, to identify and prioritize a number of best practices, and classify them in terms of their potential impact on the improvement of the quality of care and the health outcomes of patients with severe uncontrolled asthma, and their feasibility. The authors’ ambition is that the conclusions drawn from this study should help other interdisciplinary teams improve the care provided to patients suffering from severe uncontrolled asthma.

          Translated abstract

          Resumen El asma es una de las enfermedades crónicas respiratorias de mayor prevalencia e impacto sanitario y socioeconómico, especialmente en el caso de pacientes que no alcanzan un adecuado control de la enfermedad. Por ello, mejorar el manejo clínico de los pacientes con asma grave no controlada debe ser una prioridad sanitaria. En un contexto de redefinición general de los modelos de atención orientados al abordaje de la cronicidad y la personalización se ha desarrollado un proyecto para definir las bases del modelo de atención multidisciplinar del paciente con asma grave no controlada. El trabajo realizado refuerza la percepción de la necesidad de optimizar la coordinación entre niveles asistenciales, fomentar la colaboración y el abordaje multidisciplinar, y promover un modelo integral asistencial que permita adaptar la atención a los pacientes con asma grave no controlada de manera más personalizada. El trabajo ha permitido la identificación y priorización de buenas prácticas, por parte de equipos de trabajo multidisciplinares constituidos por médicos especialistas en alergología, neumología y farmacéuticos especialistas en farmacia hospitalaria, en base a su potencial impacto en la mejora de la calidad asistencial, resultados en salud del paciente con asma grave no controlada y la factibilidad de su implementación. Las conclusiones de este proyecto pretenden servir de ayuda a otros equipos de trabajo multidisciplinar con interés en mejorar la asistencia a esta patología.

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          Most cited references36

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          Anti-IL-5 therapy in patients with severe eosinophilic asthma – clinical efficacy and possible criteria for treatment response

          Background Interleukin-5 (IL-5) antibodies represent a promising therapeutic option for patients with severe eosinophilic asthma. To date, no official treatment response criteria exist. In this study, simple criteria for treatment response applicable to all asthma patients were used to evaluate clinical efficacy and predictors for treatment response in a real-life setting. Methods Data from 42 patients with severe eosinophilic asthma treated with mepolizumab for at least six months were analysed. Simple criteria to assess treatment response in clinical practice were used: increase of FEV1 ≥ 12% or ≥ 200 ml, reduction of blood eosinophils (< 150/μl or < 80% from baseline) and improvement of subjective condition (patient-judged subjective improvement or worsening following therapy). Patients were considered treatment responders if two criteria were fulfilled. Results Thirty-two out of 42 patients (76% [61–87%]) were classified as responders. Within the groups (responder vs non-responder), treatment with mepolizumab led to significant increase in FEV1 (+ 600 ml vs -100 ml, p = 0.003), oxygenation (+ 8 mmHg vs -3 mmHg, p = 0.001), quality of life (visual analogue scale; + 28% vs − 5%, p = 0.004) and Asthma Control Test (+ 8 vs + 1 points, p = 0.002). In the responder group a significant decrease in the exacerbation rate over 12 months (1.45 vs 0.45, p = 0.002) was observed. Baseline characteristics (sex, BMI, smoking history, allergies, baseline level of eosinophils) did not predict treatment response. Conclusion Using improvement of lung function, decrease of eosinophils and improvement of subjective condition as response criteria, 76% of treated patients could be classified as treatment responders, demonstrating the efficacy of anti-IL-5 therapy in clinical practice.
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            Costs of asthma according to the degree of severity

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              Costs of asthma are correlated with severity: a 1-yr prospective study

              Asthma prevalence is increasing and asthma-related costs are likely to increase, but few studies have analysed the relationship of asthma costs and severity. The impact of severity on costs was quantified in a cohort of 318 asthmatic patients followed up prospectively for 1 yr. Patients presenting with a broad range of severity of the disease (intermittent, mild persistent, moderate persistent, severe persistent) were recruited by chest physicians throughout France and treated for 1 yr according to customary clinical practice and following international guidelines. Severity, direct and indirect costs, and quality of life (QoL) were assessed. A multivariate analysis was conducted to relate factors contributing to the costs measured. Mean direct costs for goods and services excluding hospitalization, numbers of consultations, supplementary examinations, and the use and cost of bronchodilators and corticosteroids, indirect costs of days lost from work, and adverse QoL parameters all increased significantly with increasing severity. This also applied to mean age, body weight, asthma duration, depression of forced expiratory volume in one second, and inhaled corticosteroid posology in the 234 patients completing the study. There was a significant relationship (r=0.614, p<0.001) between direct costs (hospitalization and cures were excluded) and three domains of the QoL questionnaire (mobility, pain and energy). Overall costs of asthma (including individual direct costs, indirect costs, and intangible quality of life costs) are clearly related to severity. This is the first study in asthma to combine rigorous independent classification of grades of severity in statistically valid numbers of patients of grades receiving "real-world" treatment and followed-up prospectively for 1 yr. It allowed severity to be accurately related to direct, indirect and intangible costs of asthma. Quality of life explained a significant part of these costs.
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                Author and article information

                Journal
                fh
                Farmacia Hospitalaria
                Farm Hosp.
                Grupo Aula Médica (Toledo, Toledo, Spain )
                1130-6343
                2171-8695
                October 2020
                : 44
                : 5
                : 230-237
                Affiliations
                [5] Seville orgnameHospital Universitario Virgen Macarena orgdiv2Department of Pneumology Spain
                [3] Barcelona orgnameHospital del Mar orgdiv1Pharmacy Unit Spain
                [1] Valencia orgnameHospital Universitario Doctor Peset orgdiv1Hospital Pharmacy Unit Spain
                [2] Barcelona orgnameHospital del Mar orgdiv1Department of Pneumology Spain
                [4] Seville orgnameHospital Universitario Virgen Macarena orgdiv1Pharmacy Unit Spain
                [6] Lugo orgnameHospital Universitario Lucus Augusti orgdiv1Pharmacy Unit Spain
                Article
                S1130-63432020000500007 S1130-6343(20)04400500007
                10.7399/fh.11436
                fd891244-4072-4f60-9d27-f472780f19a4

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 05 July 2020
                : 16 March 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 37, Pages: 8
                Product

                SciELO Spain

                Categories
                Special Article

                Equipos de trabajo,Asma grave no controlada,Buenas prácticas,Farmacia hospitalaria,Severe uncontrolled asthma,Best practices,Working teams,Hospital pharmacy

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