Are there any unsolved problems in respiratory medicine that annoy you?
The number of CCGs that switch patients from one inhaler device to another (for financial savings) without involving the patient in the decision-making process is frustrating.
The best advice I can give is not to compromise on quality by, for example, purely focusing on financial savings. There is a Q in QIPP for a reason and this should always be to the forefront when planning initiatives at an individual/population level.
The lack of funds invested in smoking cessation services is a worry within the UK. Even though prevalence has generally reduced, there is still a lot of work to do to help the most vulnerable in society such as patients with long term conditions and mental health illness.
Other aspects of respiratory medicine when not executed to a high quality that annoys me include:
- When people are labelled with a condition such as asthma, COPD without a thorough diagnosis.
- When colleagues are given a short amount of time in the clinic with patients to do a respiratory review; in such instances, what is needed is time to explore ideas, concerns, expectations.
- When patients aren’t reviewed soon after initiating a trial of treatment to see if it suits and allowing designated time to review the patient’s self-management plan e.g. personal asthma action plan (PAAP).
- When inhaled medicines are prescribed, prior to exploring higher value non-pharmacological management e.g. smoking cessation, flu vaccination, pulmonary rehabilitation.
- When treatment is over prescribed which causes harm and waste e.g. Inhaled corticosteroid (ICS) treatment in COPD at a stage of severity that it may not be indicated.
- When there is unwarranted variation in the prescribing of SABA or high dose ICS in asthma.
- When resources aren’t spent on the whole multi-disciplinary team who come into contact with respiratory patients e.g. community pharmacists.
These are all areas for strategic improvement.