Asthma

How an Aussie respiratory clinic became a world leader in multidisciplinary care


An Australian respiratory clinic employing physicians, specialist nurses and allied health workers is proving successful both in terms of patient care and as a training ground for clinicians, staff say.

Starting out as an asthma management clinic in the early 1990s, Newcastle’s multidisciplinary airways service is among the oldest such facility in the country, having been integrated into the city’s tertiary care system for almost three decades.

Today, the set up includes an inpatient service, plus a rapid access centre and clinics for asthma management, difficult airways, drug administration, pulmonary rehabilitation. It also has an integrated research program.

As a result, it is able to offer patients with complex airway disease the widest possible range of interventions, say staff and researchers led by Professor Vanessa McDonald of the University of Newcastle department of respiratory and sleep medicine.

“We’ve become leaders both nationally and internationally in terms of multidisciplinary clinics for people with airway disease,” she tells the limbic.

“Others have emerged and continue to emerge but I think Newcastle is a bit of an exemplar in this area.”

Following a presentation to the European Respiratory Society last year, Professor McDonald and her team have published a how-to guide to building a similar service in the society’s journal, ERJ (link here)– arguing the ‘Newcastle model’ can be even further replicated.

After an eight-step start-up process including a survey of local populations and risk assessment, the key is to evolve as new treatments emerge and needs change, they suggest.

“A key change has been to evolve the service to accommodate the expanding numbers of patients receiving biologic therapy for severe asthma,” the team wrote in ERJ, adding their initial model was to administer the treatment injections at outpatient visits. This meant capacity was reached whenever the number of patients on biologic therapy went beyond about 30.

However, a shift to self-administration by patients means there are currently 10 times that number receiving regular biologic therapy for severe T2-high asthma, they said.

“An emerging issue is that of monitoring adherence, regular follow-up and managing the requirement for ongoing government approval for biologic use,” the team added.

“The service also needs to accommodate the increasing numbers of patients requiring access to the Difficult Airways Clinic assessment and therapies.”

“To do this, the service has partnered with the national Centre of Excellence in Severe Asthma and Centre of Excellence in Treatable Traits to develop educational and practice management tools to facilitate the assessment and management of severe asthma in different settings.”

There were other ongoing challenges, mostly bound up with the service’s situation within Newcastle’s John Hunter Hospital, potentially excluding patients who required assistance in other settings such as primary care.

“Resources are clearly a challenge to implementing and continually improving our multidisciplinary service, and to the best of our knowledge there are no cost-effectiveness analyses of multidisciplinary airway disease clinics such as the one we have described,” they added.

“However, we do know that this approach is associated with significantly improved health outcomes, including halving OCS requirements, reduced exacerbations, and improved quality of life and asthma control. All these outcomes lead to increased healthcare utilisation when not addressed or controlled.”

“Our team work seamlessly together (mostly) due to the structure of the service and the opportunity for collaborative care and ongoing training.

“The success of the service is due to continued quality improvement and the enabling of change with new treatments and changing capacity. A multidisciplinary approach is integral to addressing the complexity and heterogeneity of people with complex airway diseases.”

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