South West AHSN improving patient access to faster and more effective asthma diagnosis
The South West Academic Health Science Network (South West AHSN) has driven the regional implementation of an asthma diagnostic tool in primary care known as fractional exhaled nitric oxide (FeNO) testing.
The successful project has introduced FeNO testing, previously unavailable in primary care, in GP practices across the South West, where it has been embraced by staff and patients alike. In one seven-month period, over 2,000 more patients received a FeNO test to support their asthma diagnosis.
Introducing FeNO testing in primary care
FeNO is a point of care test which measures the amount of nitric oxide in a patient’s breath to increase the accuracy of asthma diagnosis. High levels of this gas can be a sign of the chronic condition, which affects more than 5.4 million people in the UK.*
With funding from former Devon Clinical Commissioning Group, the South West AHSN and the Southwest Respiratory Clinical Network have together supported the adoption of FeNO testing across the region as a part of the national Rapid Uptake Product (RUP) programme.
The aim was to improve patient care and pathways for people with suspected and confirmed asthma, as well as creating the right conditions to facilitate sustainable use of testing. Prior to the project, FeNO was not available in primary care settings. To address this, the national programme sought to provide 50% of Primary Care Networks (PCNs) with access to a device.
As a result of the regional project, 50 machines have been distributed across 34 PCNs in Devon, Somerset, Cornwall and the Isles of Scilly (see Figure 1), which has meant that 57% of the South West’s PCNs are now able to offer FeNO testing. In addition, training was given to clinical staff in these PCNs, and services were supported to evaluate the impact of introducing FeNO into their pathways.
Figure 1: The distribution of FeNO machines used by GP practices across Devon, Cornwall, the Isles of Scilly and Somerset.
To further help facilitate the use of testing, the South West AHSN also hosted four collaborative forums, which provided a virtual space for participants to discuss clinical or practical questions about implementing FeNO. Patient case studies were used as teaching material for discussion, and the forums also gave participants the opportunity to learn from subject matter experts. The speakers presented on a range of topics, from NICE asthma guidelines to severe asthma pathways and FeNO in secondary care, and attendees included primary and secondary care clinicians and commissioners.
Kara Reaney, South West AHSN’s FeNO Project Manager said:
“We’ve had a fantastic response to the project from many primary care clinicians across our region, in particular from respiratory and lead nurses. They’ve really embraced FeNO testing and have encouraged others from their surgeries and wider PCNs to find out more and get involved. They’ve also been very generous with their time, both in terms of initial engagement and more recently in gathering data and insights.
As the project draws to a close, our focus is now on evaluating the impact of FeNO in our region to ensure the sustainability of the project for the future.”
The impact of FeNO testing on patients and clinics
One of the key outcomes of the project was the huge increase in the numbers of patients in the South West receiving the test, which rose from 98 in April 2022 to 2,408 in November 2022.**
In the summer of 2022, the South West AHSN set out to understand and assess how practices were implementing FeNO, along with the impact it was having on the accuracy of asthma diagnosis and the experiences of both healthcare staff and patients. This was achieved through a survey, which was completed by 13 surgeries, followed by more detailed interviews with GPs and nurses from six practices.
Feedback showed that 100% of the practices surveyed found the machines extremely easy to set up, with FeNO slotting easily into their existing asthma pathways. All practices that responded to the usefulness question on the survey found the machine useful in establishing a diagnosis, with 36% finding it extremely useful and 64% somewhat useful.
Almost all the practices said their patients found the machines straightforward, with one practice saying: “Simple and easy to use; adds additional support in diagnosis and monitoring.”
In the follow-up interviews with staff, a few participants commented on how engaged patients were with the FeNO device, commenting that taking the test felt like playing a video game. This element was particularly welcomed by those testing children, with one interviewee highlighting that FeNO was “Very helpful, particularly in children where we wouldn’t use spirometry.”
From the 13 surgeries surveyed, 54 patients had received an asthma diagnosis following their FeNO test. 65 patients had their medication increased as a result of their test and 70 patients experienced no alteration, whereas nine people had their medication reduced and two had been taken off medication completely.***
One interviewee noted that FeNO “reduces the delay in monitoring and diagnosing asthma”, with two others stating that it had been especially useful in helping patients adhere to their medication. Furthermore, all of the staff interviewed reported that the test was helpful in providing patients with evidence of their asthma diagnosis.
The responses to the survey and interviews were overwhelmingly positive, with one GP stating:
“Sometimes new ways of working can cause issues, but FeNO has been really embraced by staff and patients.”
View a case study of our FeNO project here.
The South West AHSN has also been transforming asthma care through a collaboration with the West of England AHSN and South West Severe Asthma Network, working with 10 hospital trusts across the South West of England to improve asthma pathways and enhance access to innovative treatments for adult patients. An evaluation of has shown the project has increased regional uptake of asthma biological therapies. Learn more here.
**Data source: supplier sales data provided by IRLS Analytics.
***There are limitations to the data due to incomplete information for three to four practices responding to medication changes.
FeNO machine loans for primary care
The national AHSN Network is working with NIOX® Group and Intermedical, suppliers of respiratory diagnostic and monitoring devices, to continue providing access to FeNO machines across primary care as the project draws to a close. There will be a cost involved to hire the machines over a three-year period and participation is entirely optional. Note that NIOX® will give priority to PCNs that do not currently have access to any machines. If you would like to learn more, please email steve.johnson-wood@swahsn.com.
