Context
Anything flagged as a medical Problem (be that Active, Past Significant or Past minor) will be relevant for Practice Toolkit - if it isn't a 'Problem' it's not incorporated.
Asthma is something of a unique recall – difficult to diagnose, behaves differently for each patient, patients commonly grow out of it - it’s therefore common to have historic coding which may no longer be relevant.
Equally some will recall patients based on their medications issues, which this is functional it's 'brittle' when a re-issue may be missed or delayed.
We’d recommend undertaking an Audit of Asthma Patients; there’ll be clinical and compliance relevance even outside of Practice Toolkit.
Audit of Asthma Patients - Custom Search
Most practices will add 'Asthma Resolved' to the exclusion list in their Asthma Recall - double check that by navigating to the Settings/Recall List, clicking Asthma, then scroll down in the summary or go to the population tab. This will mean patients ever coded with Asthma Resolved are ignored from the Recall.
To audit Asthma patients; use the custom search to highlight only the subset of patients needing attention and ignore patients which don't need any changes.
Open the Asthma Folder or the Support Searches previously downloaded - or download and import below; Import as a search in EMIS (Click EMIS logo/Main menu, 'Reporting', 'Population reporting', click on the Practice Toolkit folder, click ‘Import’ in the top ribbon and use the three dots on the right to select the downloaded XML above;
Process
Each search may only be a short list of patients for actioning.
In each search, the date of the last annual review, and date of last salbutamol inhaler issued and the date of the last preventer inhaler issued are also shown, to help you judge if it should be a problem or be resolved.
“Asthma not coded as a problem”
This will search to highlight patients who have been coded with ‘Asthma’ (and/or child codes) but not as a ‘Problem’
Action all Patients in this list:
flag ‘Asthma’ (and/or child codes) as a problem,
OR
evolve the asthma coding to ‘Asthma Resolved’ (as a problem) to avoid any future confusion.
“Asthma resolved not as a problem”:
This will search to highlight patients who have been coded with ‘Asthma’ (as a ‘Problem’) AND then afterwards ‘Asthma Resolved’ coded (but not as a ‘Problem’)
Action all Patients in this list:
Update the ‘Asthma Resolved’ coding to flag as a problem (and ideally evolve the original Asthma problem),
OR
remove the Asthma Resolved coding to avoid any future confusion.
"Asthma resolved then re-diagnosed"
This search will highlight patients where they coded as 'Asthma', then 'Asthma Resolved' but then diagnosed with 'Asthma' again more recently.
Action all patients in this list and select Asthma Resolved problem, right click and change status to 'Not a problem' a confirmation message will appear, select 'Change to not a problem'.
“Asthma Register”
Search to highlight patients coded with Asthma as a problem (and NOT asthma resolved as a problem).
This is to capture patients who may have been missed, or where medication and reviews aren't in sync.This should match the Practice Toolkit Recall list (if the EMIS upload has been re-run manually and then uploaded)
Review/Action only SOME of these patients - the majority of patients should be retained on this list. To see the outliers, sort the review date columns to review differences. Whether that triggers an admin task, a filler task for clinicians 2nd on, or tasks to each usual doctor is entirely your discretion.
Patients have been issued medication recently but not reviewed. Probably should be reviewed and will be included in the recall = do nothing/move to next patient
Patients have been reviewed recently but not been issued medication. Probably should be reviewed (and may be resolved at the next review) and will be included in the recall = do nothing/move to next patient
Patients where review AND medication have not been covered recently, consider:
if these patients should be coded to Asthma Resolved (as a problem +/- evolve the Asthma problem)
OR
Communicated with to be reviewed/included in the recall.
We’d recommend re-checking searches 1, 2 and 3 after doing 4 just to ensure all changes have been done right.
Re-sync data with Practice Toolkit (manually outside England, or waiting until next day if automated.)