Journal Article

MISSION ABC: transforming respiratory care through one-stop multidisciplinary clinics – an observational study

DeVos, Ruth, Lanning, Ellie, Jackson, Richard, Amos, Mark, Rickard, Kathleen A, Sanders, Mark, Micklam, Joanne, Dominey, Rachel, Bannell, Kathryn, Maxwell, Fiona, Jones, Thomas Llewelyn, Chauhan, Anoop J, Baghammar, Jona, Longstaff, Jayne, Meehan, Dave, Leung, Anthony, Heiden, Emily, Begum, Selina, Guile, Robert, Rupani, Hitasha, Whiteman, Matt, Neville, Daniel, Pullen, Marcus, Moseley, Sara, Mottershaw, Mark, Holdsworth, Ben, Brown, Thomas, Chauhan, Milan J A

2024

Overview

ObjectivesThe Modern Innovative Solutions to Improve Outcomes in Asthma, Breathlessness and Chronic Obstructive Pulmonary Disease (COPD) (MABC) service aimed to enhance disease management for chronic respiratory conditions through specialist multidisciplinary clinics, predominantly in the community. This study assesses the outcomes of these clinics.DesignThis study used a prospective, longitudinal, participatory action research approach.SettingThe study was conducted in primary care practices across Hampshire, UK.ParticipantsAdults aged 16 years and above with poorly controlled asthma or COPD, as well as those with undifferentiated breathlessness not under specialist care, were included.InterventionsParticipants received care through the multidisciplinary, specialist-led MABC clinics.Primary and secondary outcome measuresPrimary outcomes included disease activity, quality of life and healthcare utilisation. Secondary outcomes encompassed clinic attendance, diagnostic changes, patient activation, participant and healthcare professional experiences and cost-effectiveness.ResultsA total of 441 participants from 11 general practitioner practices were recruited. Ninety-six per cent of participants would recommend MABC clinics. MABC assessments led to diagnosis changes for 64 (17%) participants with asthma and COPD and treatment adjustments for 252 participants (57%). Exacerbations decreased significantly from 236 to 30 after attending the clinics (p<0.005), with a mean reduction of 0.53 exacerbation events per participant. Reductions were also seen in unscheduled and out-of-hours primary care attendance, emergency department visits and hospital admissions (all p<0.005). Cost savings from reduced exacerbations and healthcare utilisation offset increased medication costs and clinic expenses.ConclusionsSpecialist-supported multidisciplinary teams in MABC clinics improved diagnosis accuracy and adherence to guidelines. High patient satisfaction, disease control improvements and reduced exacerbations resulted in decreased unscheduled healthcare use and cost savings.Trial registration numberNCT03096509.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adult / Ambulatory Care Facilities / Asthma / Asthma - therapy / Chronic obstructive pulmonary disease / Clinics / Cost analysis / Dyspnea / General Practitioners / Health care access / Health services utilization / Humans / Inhalers / Medical referrals / Observational studies / Participatory research / Patient Participation / Patient satisfaction / Patients / Primary care / Primary Health Care / Productivity / Prospective Studies / Pulmonary Disease, Chronic Obstructive / Pulmonary Disease, Chronic Obstructive - therapy / Quality of Life / Questionnaires / Respiratory Medicine