The barriers to accessing primary care resulting in hospital presentation for exacerbation of asthma or chronic obstructive pulmonary disease in a large teaching hospital in London

- It costs ten times more to treat severe COPD compared to mild disease, with 54% due to hospitalisation.
- Majority of patients presented to hospital during working hours on weekdays, when GPs are available.
- Majority of patients were registered with a GP.
- Less than 50% of hospital presentations were not preceded by GP contact and may have been preventable.
- Novel ways to triage patients to the most appropriate medical attention should be investigated.

Asthma and chronic obstructive pulmonary disease (COPD) account direct costs of £1 billion each per year in the United Kingdom (UK). A national review of asthma deaths found that a significant proportion of patients die without seeking medical assistance or before emergency medical care could be provided. This study aims to establish the pathway that patients undertake to access care in the lead up to an accident and emergency (A&E) attendance and/or inpatient admission. Patients attending A&E and/or following an inpatient admission due to an exacerbation of asthma or COPD were reviewed by a specialist respiratory pharmacist during weekday working hours. Over a one-year period, 920 (224 asthma and 696 COPD) presentations for exacerbation of asthma and COPD were reviewed. Although the majority of the patients were registered with a general practitioner (GP), less than 50% received medical attention from their GP and/or had an active intervention prior to presenting to hospital. These findings correlate with those found in the national review of asthma deaths. At a time of increasing demands on healthcare resources, these results pose the question of how we can better triage patients to appropriate care settings to minimise unscheduled care and improve patient outcomes.