Barriers & Hurdles when Establishing a Severe Asthma Clinic
Several barriers and hurdles need to be considered when establishing a severe asthma clinic.
These can include people resources, such as the clinician’s time and availability, access to suitably qualified specialist health care professionals, appropriate administration support and access to multidisciplinary team members (e.g. speech pathologists, dietitians, physiotherapists, psychologists, pharmacists etc).
A multidimensional assessment and management approach can improve patient outcomes (Clark et al. 2017). However, this approach is not without its challenges, and requires careful coordination and communication between team members.
Physical resources can also provide a barrier to setting up a severe asthma clinic such as access to physical space, access to equipment (such as spirometry), and access to add-on therapies (such as the monoclonal antibody therapies). Add-on therapies may require additional assessments to support confirmation of patient eligibility and for monitoring of adverse events following treatment. For example, monitoring for anaphylaxis responses following monoclonal antibody treatment.
Health care system structure may add an additional layer of complexity requiring identification of referral pathways and initial referral generation after the establishment of a new clinic. Referral pathways must be coordinated and clearly communicated. In addition, eligibility for claiming from the Medicare Benefits Schedule and/or Activity Based Funding will need to be determined before the clinic commences.
Patient related factors may also provide a barrier to the successful implementation of the severe asthma clinic. Patient factors can include poor uptake by patients due to an inconvenient location, transportation issues, travel required from rural settings, waiting lists, costs (including direct medication costs and indirect costs of time off work and clinic attendance), and/or clinic hours/flexibility.
Which barriers and hurdles are relevant and how they can be overcome will be dependent on the local context and environment. Barriers may be particularly relevant for add-on monoclonal antibody treatment, which requires repeated patient clinic attendance on a biweekly or monthly basis.
