What patients really think about asthma guidelines: barriers to guideline implementation from the patients’ perspective

Abstract

BackgroundTreatment of asthma does not always comply with asthma guidelines (AG). This may be rooted in direct or indirect resistance on the doctors’ and/or patients’ side or be caused by the healthcare system. To assess whether patients’ concepts and attitudes are really an implementation barrier for AG, we analysed the patients’ perspective of a “good asthma therapy” and contrasted their wishes with current recommendations.MethodsUsing a qualitative exploratory design, topic centred focus group (FG) discussions were performed until theoretical saturation was reached. Inclusion criteria were an asthma diagnosis and age above 18. FG sessions were recorded audio-visually and analysed via a mapping technique and content analysis performed according to Mayring (supported by MAXQDA®). Participants’ speech times and the proportion of time devoted to different themes were calculated using the Videograph System® and related to the content analysis.ResultsThirteen men and 24 women aged between 20 and 77 from rural and urban areas attended five FG. Some patients had been recently diagnosed with asthma, others years previously or in childhood. The following topics were addressed: (a) concern about or rejection of therapy components, particularly corticosteroids, which sometimes resulted in autonomous uncommunicated medication changes, (b) lack of time or money for optimal treatment, (c) insufficient involvement in therapy choices and (d) a desire for greater empowerment, (e) suboptimal communication between healthcare professionals and (f) difficulties with recommendations conflicting with daily life. Primarily, (g) participants wanted more time with doctors to discuss difficulties and (h) all aspects of living with an impairing condition.ConclusionsWe identified some important patient driven barriers to implementing AG recommendations. In order to advance AG implementation and improve asthma treatment, the patients’ perspective needs to be considered before drafting new versions of AG. These issues should be addressed at the planning stage.Trial registration DRKS00000562 (German Clinical Trials Registry).Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0346-6) contains supplementary material, which is available to authorized users.

Patient evaluations of asthma counselling quality in primary health care — a cross-sectional survey

“…More specifically, patients were satisfied with counselling that discussed asthma and its features, medication, and how to manage symptoms; this agrees with research by Lee et al (2016), who reported that counselling improves patients' knowledge of the disease and inhalation technique. Lingner et al (2017) reported contrasting findings, namely that patients were unsatisfied with counselling time and felt that they were not treated as an expert in their own asthma disease. Therefore, patients should always be afforded ample time to discuss their problems and be motivated to care for themselves.…”

“…Furthermore, successful counselling requires active interaction between the patient and healthcare staff. Only a few studies have investigated counselling from the viewpoint of an asthma patient (Lingner et al 2017), with most of the previous research focusing on counselling interventions (e.g., Clark et al 2010) or self-care (e.g., Gibson et al 2009). This study examines adult asthma patients' perceptions of counselling quality, with the quality of counselling described based on the content, implementation, and benefits of counselling, along with the available resources for counselling.…”

“…In order to be effective, asthma counselling should focus on medication, more specifically, safe dosage and correct inhalation technique (Kauppi et al 2015;Lee et al 2016). However, there is a general lack of inhalation technique counselling (Kauppi et al 2015;Lingner et al 2017), and worryingly, Hickey (2014) reports that there is also a lack of staff who are able to demonstrate the correct inhalation technique. Patients are used to taking medication and immediately experiencing a degree of relief in their symptoms.…”

“…Patients are used to taking medication and immediately experiencing a degree of relief in their symptoms. However, healthcare professionals should focus on counselling asthma patients about how lifestyle, e.g., physical activity and smoking, influences asthma symptoms (Lingner et al 2017). For example, it is well known that smoking (Murray & O'Neill 2018) and high BMI (Wright et al 2010) increase the risk of experiencing asthma attacks.…”

“…Throughout the counselling process, healthcare staff should interact with, and observe, patients to identify the best approach for educating the patient about how to manage with asthma (Kääriäinen & Kyngäs 2010;Raitanen et al 2015). Furthermore, healthcare staff should keep in mind that asthma may cause distress to the patienteither through asthma attacks or medication (Lingner et al 2017). This is additional evidence of why good counselling is important for asthma patients.…”