Improving primary care management of asthma: do we know what really works?

Fletcher, Monica; Tsiligianni, Ioanna; Kocks, Janwillem; Cave, Andrew; Chi, Cheng; Sousa, Jaime Correia de; Román-Rodríguez, Miguel; Thomas, Michael; Kardos, Péter; Stonham, Carol; Khoo, Ee Ming; Leather, David; Molen, Thys van der

doi:10.1038/s41533-020-0184-0

Cited by 30 publications

(28 citation statements)

References 78 publications

(94 reference statements)

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“…Heavy workload and inadequate training were two important barriers to low adherence by primary care doctors to the guidelines [ 23 ]. Clinical pathway and supporting educational materials can be created and used to translate the evidence-based guidelines into succinct algorithms and facilitate the asthma care by primary care doctors [ 24 , 25 ]. Effective asthma self-management requires a comprehensive approach comprising of patients’ education and resources, professional skills and motivation and organisation priorities and routines [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Hajj health examination for pilgrims with asthma in Malaysia: An ethnographic study

et al. 2022

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Background Asthma was one of the top causes of hospitalization and unscheduled medical attendances due to acute exacerbations and its complications. In Malaysia, all pilgrims must undergo a mandatory health examination and certified fit to perform pilgrimage. We studied the current organisational and clinical routines of Hajj health examination in Malaysia with a focus on the delivery of care for pilgrims with asthma. Methods We conducted non-participant observation to obtain ethnographic understanding of Hajj health examination activities for 2019. Observations were guided by a checklist and recorded as notes that were analysed thematically. The study was conducted at 11 public (from each region in Malaysia, namely, North, South, East, West of Peninsular Malaysia, and Sabah and Sarawak of East Malaysia) and two private primary care clinics. Results We observed considerable variation in the implementation and practice of Hajj health examinations among the 11 public clinics but no marked variation among the private clinics. The short time span of between three to four months was inadequate for disease control measures and had put pressure on health care providers. They mostly viewed the Hajj health examination as merely a certification of fitness to perform the pilgrimage, though respiratory health assessment was often inadequate. The opportunity to optimise the health of pilgrims with asthma by providing the appropriate medications, asthma action plan and asthma education including the preventive measures was disregarded. The preliminary health screening, which aimed to optimise pilgrims’ health before the actual Hajj health examination was not appreciated by either pilgrims or health care providers. Conclusions There is great potential to reform the current system of Hajj health certification in order to optimise its potential benefits for pilgrims with asthma. A systematic approach to restructuring the delivery of Hajj health examination could address the time constraints, clinical competency of primary health care providers and resources limitations.

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Section: Discussionmentioning

confidence: 99%

Hajj health examination for pilgrims with asthma in Malaysia: An ethnographic study

et al. 2022

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“…The popularity of an asthma app may not yield information regarding the quality of the asthma content presented in the app with respect to the clinical or scientific literature. Prior studies have observed variability in the quality of asthma information with respect to its consistency with National Asthma Education and Prevention Program guidelines [ 3 ]. Future studies should examine the concordance between asthma education and asthma management clinical tools within popular asthma apps.…”

Section: Discussionmentioning

confidence: 99%

“…Many factors combine to contribute to poor asthma rates and worsen outcomes. Provider practice behaviors, suboptimal access to health care, lack of patient knowledge regarding proper medication use, and patients’ difficulty adhering to medical regimens contribute to poor asthma outcomes [ 3 - 8 ]. With appropriate medical care including education, patients can achieve asthma control; however, there are competing challenges to providing effective patient education, such as time constraints and prioritizing other issues above asthma education [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluating Asthma Mobile Apps to Improve Asthma Self-Management: User Ratings and Sentiment Analysis of Publicly Available Apps

Camacho-Rivera

Huang

et al. 2020

JMIR Mhealth Uhealth

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Background The development and use of mobile health (mHealth) apps for asthma management have risen dramatically over the past two decades. Asthma apps vary widely in their content and features; however, prior research has rarely examined preferences of users of publicly available apps. Objective The goals of this study were to provide a descriptive overview of asthma mobile apps that are publicly available and to assess the usability of asthma apps currently available on the market to identify content and features of apps associated with positive and negative user ratings. Methods Reviews were collected on June 23, 2020, and included publicly posted reviews until June 21, 2020. To characterize features associated with high or low app ratings, we first dichotomized the average user rating of the asthma app into 2 categories: a high average rating and a low average rating. Asthma apps with average ratings of 4 and above were categorized as having a high average rating. Asthma apps with average ratings of less than 4 were categorized as having a low average rating. For the sentiment analysis, we modeled both 2-word (bi-gram) and 3-word (tri-gram) phrases which commonly appeared across highly rated and lowly rated apps. Results Of the 10 apps that met the inclusion criteria, a total of 373 reviews were examined across all apps. Among apps reviewed, 53.4% (199/373) received high ratings (average ratings of 4 or 5) and 47.2% (176/373) received low ratings (average ratings of 3 or less). The number of ratings across all apps ranged from 188 (AsthmaMD) to 10 (My Asthma App); 30% (3/10) of apps were available on both Android and iOS. From the sentiment analysis, key features of asthma management that were common among highly rated apps included the tracking of peak flow readings (n=48), asthma symptom monitoring (n=11), and action plans (n=10). Key features related to functionality that were common among highly rated apps included ease of use (n=5). Users most commonly reported loss of data (n=14) and crashing of app (n=12) as functionality issues among poorly rated asthma apps. Conclusions Our study results demonstrate that asthma app quality, maintenance, and updates vary widely across apps and platforms. These findings may call into question the long-term engagement with asthma apps, a crucial factor for determining their potential to improve asthma self-management and asthma clinical outcomes.

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“…Setting up a team in primary health care asthma control has improved globally in recent decades, however, in spite of the availability of effective treatments, it remains sub-optimal 25 and it is a substantial reason for direct and indirect costs. 26 Uncontrolled asthma affects a significant ManaGinG aSTHMa in PHc cOrreia-de-SOUSa vol. 112 -no.…”

Section: The Importance Of the Primary Health Care Team For The Follo...mentioning

confidence: 99%

Managing asthma in primary healthcare

Sousa

Vicente²,

Brito

et al. 2021

Minerva Med

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asthma brings considerable challenges for family doctors because of its variety of shapes, different levels of severity, a wide age range, and the fact that in the last decades clinicians are able to offer much better treatment options with a better level of disease control and a higher quality of life. The objectives of the current review article are to provide an up-todate review by primary care respiratory leaders from different countries of the most significant challenges regarding asthma diagnosis and management, the importance of team work and the problems in recognizing and dealing with difficultto-manage and severe asthma in primary care. The article provides a short review of the main challenges faced by family physicians and other primary health care professionals in supporting their patients in the management of asthma, such as asthma diagnosis, promoting access to spirometry, the importance of a multiprofessional team for the management of asthma, how to organize an asthma review, the promotion of patient autonomy and shared decision-making, improving the use of inhalers, the importance of the personalized asthma action plan, dealing with difficult-to-manage and severe asthma in primary care and choosing when, where and how to refer patients with severe asthma. The article also discusses the development of an integrated approach to asthma care in the community and the promotion of asthma right care.

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Improving primary care management of asthma: do we know what really works?

Cited by 30 publications

References 78 publications

Hajj health examination for pilgrims with asthma in Malaysia: An ethnographic study

Hajj health examination for pilgrims with asthma in Malaysia: An ethnographic study

Evaluating Asthma Mobile Apps to Improve Asthma Self-Management: User Ratings and Sentiment Analysis of Publicly Available Apps

Managing asthma in primary healthcare

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