Inadequate specialist care referrals for high-risk asthma patients in the UK: an adult population-based cohort 2006?2017

Objective: To improve asthma morbidity and mortality in the UK, national asthma guidelines recommend referral to \ specialist care for the following high-risk groups, after a hospital admission for asthma, ?3 courses of oral corticosteroids (OCS) in 12 months, an incident high-dose inhaled corticosteroid (ICS) prescription or addition of a fourth asthma drug to a patient?s maintenance regimen. We sought to assess the prevalence and temporal change of referrals to identify unmet needs. Methods: We used UK electronic healthcare records, 2006?2017, to identify high-risk asthma patients managed within primary care. Referrals to respiratory clinics in secondary care were measured, within 3?months before or 6?months after, an incident ICS, third OCS in a year, or fourth asthma drug; or 12?months after a hospital admission for asthma. A nested case-control and conditional logistic regression was used to evaluate factors associated with receiving a referral. Results: A total of 246,116 asthma patients were eligible. There was a slight increase in secondary care referrals from 2014 onwards but the percentage remained low with <20% in each high-risk group referred for specialist care. The factors in the past year that were most strongly associated with receiving a referral were a hospital admission or A&E visit for asthma, ?3 OCS courses, ?2 add-on drugs, or high-dose ICS prescription. Conclusions: The majority of high-risk asthma patients were not referred for specialist care, as recommended by national guidelines. Compared to other risk factors, those admitted to hospital were most likely to receive a referral.