Research
Reprinted from AJGP Vol. 51, No. 4, April 2022 257 © The Royal Australian College of General Practitioners 2022
Nicholas A Zwar, Iqbal Hasan,
Andrew Hayen, Anthony Flynn,
Judy Mullan, Elizabeth J Halcomb,
Andrew Bonney
Background and objective
The Giving Asthma Support to Patients
(GASP) program, developed in New
Zealand, guides practice nurses to
provide structured asthma care. This
study assessed GASP in the context
of Australian general practice.
Methods
The study used a pre–post design
and was conducted in 19 practices
in Western Sydney and Illawarra/
Shoalhaven. Patients aged 5–70 years
with moderate-to-severe asthma were
invited to participate. Of the 289 patients
who attended an initial GASP
consultation, 153 attended for one or
more follow-up visits. Outcomes were
exacerbations requiring medical
intervention in the previous 12 months,
asthma control in the previous four
weeks and quality of asthma care at
the time of GASP consultation.
Results
There was a decrease in patients having
one or more exacerbations (113 [74%]
versus 80 [52%], P <0.001), and an
increase in patients with good asthma
control (21 [14%] versus 40 [26%],
P <0.005). There was no significant
change in the quality of asthma care
variable.
Discussion
Implementation of the GASP program
was associated with improvement in
asthma outcomes.
ASTHMA ACCOUNTS FOR 2.4% of the
Australian burden of disease affecting
10% of Australians across the lifespan,
impacting quality of life and participation
in work and school and leisure activities.
1
Despite the significant burden, many
people with asthma do not receive
evidence-based care.
2,3
There is evidence
that regular structured review and
support for self-management leads to
better asthma outcomes, and this is
recommended in both Australian and
international guidelines.
3–5
However,
initiatives to support the provision of
planned care, such as the Asthma 3+ visit
plan, have not achieved lasting success.
6
Qualitative work with Australian general
practitioners (GPs) found that time and
suitable remuneration were barriers for
GPs to providing structured review,
7
and GPs indicated support for a nurse or
other health professional to take on the
task of patient support and education.
7
Most general practices in Australia now
employ one or more practice nurses (PN)
and PNs play a key role in the care of
patients with chronic conditions.
8
The Giving Asthma Support to Patients
(GASP) program was developed by
Comprehensive Care Limited, and has
been implemented in general practices
in New Zealand. The GASP program
consists of an educational program for
PNs and an online computerised decision
support tool that helps to structure asthma
assessment and care, including education
to patients, in general practice.
7,9,10
This
includes recording spirometry results,
asthma symptoms, exacerbations, peak
flow measurement, asthma triggers,
medication adherence, inhaler technique
and review of action plans. Based on the
information entered, GASP provides
suggestions for pharmacological and
non-pharmacological interventions
according to clinical practice guidelines.
10–12
In a retrospective cohort study evaluating
the GASP program in New Zealand,
improvements were found in asthma
exacerbations, use of oral steroids, use
of reliever medication and health service
use, including emergency department
visits and hospitalisations.
13
Prior to the commencement of this
study, the Asthma Foundation of NSW
(now Asthma Australia), in collaboration
with Comprehensive Care Limited,
adapted the GASP program for the
Australian context. This included ensuring
recommendations provided via the tool
were consistent with the Australian asthma
handbook.
4
Despite efforts to do so, it was
not possible to integrate the GASP tool to
function with commonly used electronic
medical records software products.
The study aimed to assess whether the
use of the GASP program in Australian
general practice was associated with
improved asthma outcomes. It was
hypothesised that patients would
experience a reduction in exacerbations
requiring medical intervention and
improved asthma control. It was also
hypothesised that the GASP program
would improve the quality of asthma
care provided.
Giving Asthma Support to Patients
(GASP) program evaluation