Using a knowledge translation framework to identify health care professionals’ perceived barriers and enablers for personalised severe asthma care

Abstract

Background Whilst multidimensional assessment enables the detection of treatable traits in severe asthma and has the potential to improve patient outcomes, healthcare disparities exist, and little is known about the factors influencing optimal management in severe asthma. This study aimed to explore perceived barriers, and enablers to implementing personalised care in severe asthma, from the healthcare professionals’ perspective. Methods A descriptive, qualitative study involving a single focus group (n = 7) and semi-structured interviews (n = 33) with multidisciplinary healthcare professionals involved in severe asthma care was conducted. A hybrid thematic and content analysis was undertaken to identify themes, which were then deductively mapped to the Theoretical Domains Framework (TDF). Results Overall, three emergent themes were identified: (1) Barriers- (2) Enablers- to optimal management; (3) Desired model of care. Across all TDF domains, 6 constructs influenced development and implementation of optimal care: (1) belief about consequences, (2) environmental context and resources, (3) belief about capabilities, (4) social/professional role and identity, (5) goals and (6) knowledge. Conclusion Implementation of personalised care in severe asthma is complex and non-linear. The use of a theory-based approach effectively demonstrated how a variety of behaviours could be targeted to optimise and promote personalised care in different clinical setting.

Treatable traits, combination inhaler therapy and the future of asthma management

“…Using this teambased approach can take the pressure off time-restricted consultations with the physician alone. 17,58,59 In a study by Majellano et al 56 clinicians also perceived that patient knowledge was often poor and adherence was suboptimal, conversely in a study from McDonald et to know more about their disease and its management from their health care provider and that they frequently 'did not feel heard or recognised'. 53 If we are to effectively translate treatable traits to practice, we must address this discordance.…”

“…From the perspective of these clinicians, personalized care in severe asthma was both desirable and challenging but the barriers for implementation were multilevel spanning patient-, system-and provider-related factors. 56 These are presented in Figure 4.…”

“…In a study by Majellano et al 56 clinicians also perceived that patient knowledge was often poor and adherence was suboptimal, conversely in a study from McDonald et al that sought to understand the patient experience of people with asthma and COPD, participants indicated that they wanted to know more about their disease and its management from their health care provider and that they frequently ‘did not feel heard or recognised’ 53 . If we are to effectively translate treatable traits to practice, we must address this discordance.…”

“…A qualitative study by Majellano et al, sought to understand the barriers to the implementation of personalized medicine strategies for the management of severe asthma among 40 health care professionals from multidisciplinary backgrounds. From the perspective of these clinicians, personalized care in severe asthma was both desirable and challenging but the barriers for implementation were multi‐level spanning patient‐, system‐ and provider‐related factors 56 . These are presented in Figure 4.…”

Treatable traits models of care

“…In terms of the latter, as a respiratory community clinicians, researchers and patients have recognized that one size does not fit all! 12,13 That chronic respiratory diseases are complex, heterogeneous and associated with either an increasing or continuing disease burden, and that new approaches to improve outcomes for patients are urgently needed 12,14 . Treatable traits is a potential solution to these challenges 1,14–22 …”