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FeNO mission sees thousands of new asthmatics diagnosed
58,000 new asthmatics diagnosed, 1,244 additional FeNO testing devices in primary care, 53% of primary care networks now with access to FeNO testing in England and almost 5,000 hours of training completed. It’s all thanks to the efforts of the Wessex AHSN FeNO Programme, which has reported huge successes since inception in March 2021.1 We’re taking a look and asking: could this success go global?
Part of the NHS England Accelerated Access Collaborative (AAC)’s Rapid Uptake Programme, the aim of the plan was to improve patient outcomes through effective integration of FeNO testing for the diagnosis and monitoring of asthma in primary care. The programme supported the NHS to significantly increase patient access to FeNO testing, while also increasing staff capability through dedicated training. “The programme’s greatest legacy is improving the lives of people with suspected asthma or diagnosed with asthma as a result,” the organisers say.a
How was success achieved?
The programme included the creation of a FeNO implementation toolkit which, to date, has reached almost 14,000 views while more than 700 people joined the national learning collaborative series. 33 AAC Pathway Transformation Fund projects were awarded, totalling £915,000 and supporting 118 more FeNO devices to become embedded in clinical practice.
What contributed to such enormous achievements and could this success be achieved elsewhere in the world? The AHSN says it has identified a number of ingredients for success:
- Staff involvement and pathway redesign are key
- Communication, partnerships and collaboration are essential
- The right people are vital, including engaged patients and clinical leaders
- Measurement, data and outcomes should be explored early in the project to support impact analysis and long-term use
- Plans should be underpinned by sound theory, planning and processes
- Build on the broader health inequalities to optimise FeNO adoption
- Programme management, sharing of best practice and training are fundamental
- Oversight by a cohesive, diverse and empowered steering group
The results are inspirational and could be replicated within other healthcare networks globally. The AHSN estimates that around 89,000 people in England could be benefitting from FeNO testing in a diagnostic capacity, meaning healthcare resources are directed where they are meant to be.
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CASE-STUDY
Hereford Medical Group reported “direct impact on patients through confidently confirming or refuting an asthma diagnosis”, resulting in drug cost savings due to the de-prescribing of inhalers. Over the course of this project alone, 405 FeNO tests were completed: 226 for diagnostic purposes and 179 for monitoring. 130 people received an asthma diagnosis as a result of the revised pathway with FeNO. The impact on prescribing was also significant:
- 20 MART inhalers stopped
- 44 inhaled corticosteroid inhalers stopped
- 10 triple therapy inhalers stopped
- One dual therapy inhaler stopped
- 40 SABA stopped
Together, these amount to an annual saving of £17,111 a year, and 3,166 miles from a carbon emissions perspective. What’s more, 78 people were taken off the asthma register, saving 26 hours of nursing time.
CASE-STUDY
Durham Dales Healthcare Federation (DDHF) implemented FeNO testing across three rural areas. FeNO was integrated into clinical pathways, with regular clinics. Around 50 staff were trained in FeNO testing. As a result:
- 129 patients were tested
- 31% had their medication checked/changed
- 37% were ruled out of having asthma and no longer required inhalers
The team estimates a net saving of £259 per month, or £3,108 per year, across just those 129 patients. People in whom asthma was ruled out no longer require an inhaler, equating to a total cost saving of £416.50 per month, or just shy of £5,000 a year. Collectively, the DDHF estimates an annual saving of more than £8,000 across 178 patients. As FeNO testing increases and associated costs are considered, such as reduced emergency department attendance or fewer hospital admissions, this figure could go up.
“Really powerful”
Increasing access to FeNO testing has also helped patients understand their condition. One advanced respiratory nurse practitioner reported: “Having the ability to demonstrate a numerical response supported patient understanding. There were some clear lightbulb moments for patients, who commented that it had never been described like this before. One chap with diabetes likened it to measuring his blood sugar. Really powerful.”
The AHSN reflects that “success breeds success”. The organisers said: “As the programme began delivering on its objectives, successful delivery opened up opportunities for further development and to build on what has already been established, snowballing the scale and impact.” Competing pressures mean any new pathway must embed to show impact but give it time to develop and deliver, they advise.
For a quick and easy introduction to FeNO testing in practice, head over to our practical guides.
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References
1. National FeNO Programme Impact Report. May 2023. Accessed July 2023.