Feasibility of a Digital-First Approach to Inhaler Optimisation in Asthma Care: Support Net Zero NHS Goals

Leicester, Leicestershire and Rutland Integrated Care Board

Project summary

This project is innovative in how it combines population health analytics, digital patient engagement and structured clinical safety criteria to deliver inhaler optimisation at scale, with a pathway that integrates into routine general practice workflow.

While inhaler switching itself is well established, this project moves beyond traditional opportunistic or appointment-based clinician‑led reviews by using a digital platform to proactively identify suitable cohorts, engage patients remotely, and support shared decision‑making without default reliance on face‑to‑face appointments. The use of SMS‑led engagement, consent capture, and quality metric capture with ACT scoring enables safe stratification of patients, ensuring only clinically appropriate switches are progressed.

The platform automatically stratified patients into clinical cohorts using eligibility rules, engagement status, ACT scores and patient preference. A clear user guide directed practices on next steps, ensuring only appropriate patients progressed to remote switching, while those with uncontrolled asthma or additional needs were flagged for review.

Live dashboards allowed practices to prioritise actions, track progress and view outcomes in real time, while centralised engagement delivered follow‑up messaging and NMS prompts. Prescribing decisions remained firmly with GP practices, preserving clinical autonomy while reducing administrative burden. This combination of digital engagement, clinical triage, workflow integration and outcome tracking represented a change from traditional opportunistic inhaler reviews.

A key innovation was the blended engagement model. Digital access was supplemented with a CQC‑accredited patient support hub, allowing telephone follow‑up for non‑responders and patients needing additional reassurance. This significantly improved reach and equity while maintaining efficiency. Integration of carbon impact measurement using the PrescQIPP Carbon Impact Tool provided objective sustainability outcomes rarely embedded within routine optimisation work.

Importantly, the model is designed as an end‑to‑end pathway (identify, consent, prescribe, follow up), addressing known implementation gaps that limit system‑wide impact. The approach demonstrates how digital tools can support safer, greener prescribing while reducing unwarranted variation and workload in general practice.