Asthma - It’s as easy as 1, 2, 3+

At the mere mention of the Asthma 3+ visit, grown professionals cringe and practice staff roll their eyes in dismay. What is it about this HIC incentive that has everybody running for cover?

Anecdotally, some GPs report difficulty in encouraging patients to return for their third visit, while others are reluctant to document a written action plan due to time constraints. So despite meeting the criteria in the care of their patients, many practices are not claiming the $100 service incentive payment (SIP).

Asthma in Australia
In Australia, asthma remains one of the major reasons to be admitted to an emergency department and is the cause of 3% of GP visits. The prevalence of asthma is high by international standards, affecting up to 16% of children and 12% of the adult population, though encouragingly, deaths due to asthma fell by 21% in 2003. Professor Michael Abramson, spokesperson for the National Asthma Council states “long-term, multi-faceted initiatives like the 3+ visit plan for GPs are having a real impact and ultimately saving lives.”*

So how could a financial incentive be benefiting the patient? The key to managing asthma is assessment, review and self-management, which are all part of the Asthma 3+ visit. The asthma action plan also provides patients with a pocket guide to managing their condition; increases their confidence to deal with their symptoms, particularly if they increase in severity; and improves patient compliance.

Asthma 3+ Visit – The Holy Grail
The annual Asthma 3+ Visit involves a minimum of three visits throughout a four-week to four-month timeframe, with two of those visits being planned recalls. Patients with moderate to severe asthma qualify, that is those who have symptoms most days; those who use a preventer medication, or use a bronchodilator at least three times a week; those who have had a hospital attendance following an acute exacerbation; or those with difficult to control asthma. The visits need to include an assessment of the patient’s lung function, and currently this may be using either a peak flow or a spirometer, though spirometry is recommended (see GPSpeak May 2004).

Visit 1
The first visit is a good time to review the patient’s history, symptoms, triggers and medication. Consideration may be given to a home medicines review (HMR) if there is any concern about drug interactions or the way in which the patient may be administering their medication. It is worth noting that 50% of patients are reported to use their inhaler ineffectively, with some absorbing as little as 6-7% of their medication as a result**. Spacers improve medication absorption by dispersing the inhalant into fine particles and allowing patients to use one vital or several tidal breaths to inhale, which is useful in acute asthma.

Visit 2
The second review is a good time to introduce further education and resources, such as Asthma Australia, and complete the asthma action plan. Time may be a factor in these visits, and practice nurses can improve efficiency by taking over the spirometry and education components. Now it’s time to encourage the patient to return for the third visit and the best way to do that is to organise an appointment before they leave the surgery. It is also worth considering bulk billing the third visit as an incentive to attend, knowing the practice will be compensated for any monetary loss by the $100 SIP payment.

Visit 3
The third visit needs to include a review of the asthma action plan to ensure the patient understands what is required and to be sure the plan is working for them. It may also be worth reinforcing any education at this time, exploring other symptom triggers, and considering back titration of medication. Finally, after the third visit, a lot of effort, and a patient who is now confident to self-manage their condition, remember to claim the special incentive item number – Level B 2546, Level C 2552, or Level D 2558.

If you would like any further information or if you would like to borrow the Rural Health Education Foundation video** on this topic, please contact one of your practice liaison officers at the division – Therese or Kirsty - on 6622 4453.

Therese Greenlees is the division’s practice liaison officer.

*Statistics and further information available on the National Asthma Council website www.nationalasthma.org.au