Management of chronic breathlessness in primary care: what do GPs, non-GP specialists, and allied health professionals think?

Abstract

Background. To explore the perspectives of GPs, non-GP specialists, and allied health professionals on the role of primary care in diagnosing and managing chronic breathlessness, the barriers faced, and the resources needed to optimise care of patients with chronic breathlessness. Methods. This was a qualitative study involving focus group discussions that included 35 GPs, non-GP specialists, and allied health professionals. Topics explored included:(1) views on the role of primary care in diagnosing and managing chronic breathlessness;(2) barriers to optimal assessment in primary care; and (3) facilitators to further optimise the care of patients with chronic breathlessness. Results. All participants considered that primary care has a central role to play in the assessment and management of chronic breathlessness, but greater access to referral services, suitable funding structures, and upskilling on the use of diagnostic tests such as spirometry and electrocardiography are required for this to be realised. Both GPs and non-GP specialists described great potential for developing better linkages, including new ways of referral and online consultations, greater ease of referral to allied health services, even if conducted virtually, for patients with functional causes of breathlessness. Participants identified a need to develop integrated breathlessness clinics for patients referred by GPs, which would ensure patients receive optimal care in the shortest possible time frame. Conclusions. GPs are crucial to achieving optimal care for breathless patients, especially given the multifactorial and multimorbid nature of breathlessness; however, there are significant gaps in services and resources at present that limit their ability to perform this role.

“It's like a forgotten issue sometimes …”: Qualitative study of individuals living and caring for people with chronic breathlessness

“…Providing greater access to further diagnostic tests which are not always accessible in primary care as reported in prior studies with Australian GPs and specialists 7,8 …”

“…Community diagnostic centres where GPs can refer to Opening up direct referral to hospital-based spirometry for GPs Concerns of misdiagnosis by participants with rare conditions such as scleroderma and common ones such as asthma Providing greater access to further diagnostic tests which are not always accessible in primary care as reported in prior studies with Australian GPs and specialists 7,8 Formation of breathlessness referral services 9 to enable integrated assessment Provide primary care greater support, including digital resources and decision support systems 8 Management of chronic breathlessness Lack of nonpharmacologic support as adjuncts to treatment Previous studies have reported simple tools such as a hand-held fan to relieve breathlessness 10 Greater access to allied health and other nonphysician health professional deliver this support in addition to vital nonpharmacologic therapies such as pulmonary rehabilitation which significantly improve clinical outcomes 11 Lack of action plans and patient education materials Development of breathlessness action plans Development of high-quality patient education materials and apps for breathlessness self-management 12 hypothesised may be due to a knowledge gap regarding diagnostic tests such as spirometry. Others appreciated the GPs doing the maximum that they can and encouraged people to find a doctor that listens and understands breathlessness.…”

Yonder: Kidney stones, Advanced Practice Nurses, breathlessness clinics, and digital addictions

“…Issues of growing importance like pollution and long COVID make it even more relevant. A recent Australian study looked at the role of primary care in chronic breathlessness, 3 finding that both GPs and non-GP specialists acknowledged great potential for developing better links between services, including new ways of referral and online consultations, and greater ease of referral to allied health services. Participants identified a need to develop integrated breathlessness clinics for patients referred by GPs, which would ensure patients receive optimal care in the shortest possible time frame.…”