Assessing the impact of the new NICE asthma guidelines

About the Project

Clinicians, researchers and policy makers are anticipating the release of new joint British Thoracic Society/ Scottish Intercollege Guidelines Network/National Institute for Health and Care Excellence (BTS/SIGN/NICE) asthma guidelines. These guidelines are often used by other countries as a base for their own asthma guidance, but establishing whether guideline advice leads to a change in clinical practice is not simple.

NICE produces impact reports but these summarise clinical data rather than show a clear link between guidance and subsequent change in practice. The 2020 NICE impact statement on respiratory conditions described a welcome increase in the number of patients with a written asthma action plan (based on data from the Asthma UK 2019 annual survey) and in the number of people who had their asthma control monitored at annual reviews (from the 2018/19 quality outcomes framework). One paper demonstrated an increase in the prevalence of COPD following NICE COPD guidelines based on analysis of the Health Improvement Network. These are important improvements but whether they relate to the impact of NICE guidance is unclear and the evidence base for measuring guideline impact is limited.

Other countries have data on guideline impact: The Japanese Asthma and Prevention Guidelines, regularly revised by the Japanese Society of Allergology, have contributed to the increased use of inhaled corticosteroids, which is thought to have reduced asthma mortality in Japan. Finland, through its comprehensive National Asthma Programme, has also reduced the healthcare burden associated with asthma whilst reducing asthma-related healthcare costs concomitantly. These interventions show that changing clinician behaviour based on the best available evidence is crucial in asthma, where safe effective treatment is available, and that establishing the correct diagnosis can prevent years of potentially expensive therapy being administered.

This project will attempt to establish the impact, and behaviour change, of new national asthma guidelines by examining various databases and routinely collected datasets. These will include measuring prescribing behaviour via OpenPrescribing and the NHS Business Services Authority (NHSBSA), and clinical outcomes via the Clinical Practice Research Datalink (CPRD) and hospital episode statistics (HES) to track asthma diagnoses, exacerbations and admissions.

It is expected that the PhD project will help the candidate acquire a large number of transferable skills including paper writing, analytics, data handling, literature searching, project management and presentation skills, and lead to high impact publications and future grant collaborations. The role will be based at Glenfield Hospital, in the respiratory biomedical research centre, an intentionally regarded centre of respiratory excellence, with a supervisor who has trained 12 PhD students to successful completion, all of whom are now employed in the health/life sciences sector.