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NORTH WEST LONDON

INTEGRATED RESPIRATORY & ALLERGY CARE PATHWAY PROJECT

AIMS

Improve the patient pathway for all children with allergic conditions by earlier recognition, accurate diagnosis and effective management. This will be achieved by increasing the clinical knowledge, diagnostic and management skills through training and the building of professional networks across the care settings.

OUTCOMES

For children and their families this will ensure timely access to diagnosis and evidence based interventions as close to home as possible thereby improving health and quality of life outcomes. For both professionals and families we will be developing and delivering a new model of community based care through the creation of a seamless and unified service by networking between all levels of care and stakeholders. The framework would enable the development of professional knowledge and skills and provide a framework for the introduction of care pathways for other conditions.

INDICATORS OF ACHIEVEMENT

METHODS

NORTH WEST LONDON

INTEGRATED RESPIRATORY & ALLERGY CARE PATHWAY PROJECT

BACKGROUND TO THE PROJECT

Despite increasing prevalence of allergic conditions, which now constitute the commonest chronic diseases in the young, successive reports have identified inadequate health service provision for allergic children (1-5). As a result the Department of Health funded the Royal College of Paediatrics and Child Health to develop evidence based care pathways to address the gap in services. The programme was chaired by Professor John Warner and included comprehensive representation of all stake-holders.

The pathways have undergone an exhaustive approval process and are now ready for implementation. In order to achieve flexibility and progressively move management closer to the child's home the pathways are based on identifying the clinical competences required to provide a gold standard service rather than defining where the care should be delivered. Being competency based means they are not setting specific but will be defined by the competence of the health care professional team.

Healthcare professional interactive education sessions have been shown to improve the management of childhood asthma (6) and establishing primary care services has demonstrated benefits (7). We aim to improve on this through the development of sustainable services and creation of both professional and patient networks. To achieve this training tools and materials have been developed and are available for use. We have also developed patient/ parents educational materials and action plans including web- based programmes. Funding from the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research Care (CLAHRC) for North West London has been secured for the implementation of the integrated care pathways over the next 18 months within Hammersmith and Fulham, Kensington and Chelsea and Westminster. We have developed a project board and are now recruiting GP practices in which to commence the programme.

REFERENCES

The pilot is funded by NW London Collaboration for Leadership in Applied Health Research (CLAHRC) and is lead Imperial College, partners fully committed include: Royal College of Paediatrics, Central London Community Healthcare, Asthma UK and the Anaphylaxis Campaign.

NORTH WEST LONDON

INTEGRATED RESPIRATORY & ALLERGY CARE PATHWAY PROJECT

OUR VISION

The project will improve the management of children's allergic conditions and therefore their experience of them in Hammersmith & Fulham, Kensington & Chelsea and Westminster. Whilst national statistics would suggest that there should a diagnostic prevalence of around 20% for asthma in 10-14 year olds (1) within the population of the three boroughs, the current GP data identifies rates ranging from 2.6%-17% (2). Further studies across the country show 80% of children with asthma are allergic to one or more allergen (3). The project aims to increase the number of children diagnosed accurately from an early age with the objective to induce clinical remission in most children as early as possible thereby improving their quality of life and reducing the need for emergency care (4). As well as causing significant morbidity studies have shown that allergy symptoms impair the exam performance of teenagers (5).

There will be earlier recognition, diagnosis and management within primary care with better responses to children in the home and other settings. Children and their families will be able to live fuller lives with less anxiety, managing their conditions more effectively. They will have easier and greater local access to diagnosis and evidence based interventions within primary care through better responses from all the professionals with whom they come into contact. They will have less urgent calls on health care because their condition will be better managed by them, their peers, parents and locally based professionals. This will be achieved by increasing clinical knowledge, diagnostic skills and competence in primary and community care with carers and other professionals being able to respond more effectively wherever children are being looked after � home, children's centre, primary care or school.

REFERENCES

The pilot is funded by NW London Collaboration for Leadership in Applied Health Research (CLAHRC) and is lead Imperial College, partners fully committed include: Royal College of Paediatrics, Central London Community Healthcare, Asthma UK and the Anaphylaxis Campaign.




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