Implementation of remote asthma consulting in general practice in response to the COVID19 pandemic: evaluation using extended normalisation process theory

BackgroundThe COVID-19 pandemic has led to the rapid and reactive deployment of remote consulting in UK General Practice. The delivery of acute and chronic asthma care has been affected. Extended Normalisation Process Theory (eNPT) provides a framework for evaluating the implementation of new complex interventions in routine practice, including examination of how context-intervention interactions affect Implementation.AimTo explore the implementation of remote asthma consulting in UK General Practice in response to the COVID-19 pandemic.Design & settingMixed methods evaluation, informed by eNPT.SettingGeneral Practice in Northern Ireland.MethodData was collected from a range of healthcare professionals who provide asthma care using online questionnaires, interviews and multidisciplinary focus groups. Analysis was informed by eNPT.ResultsWe identified ten themes to describe and explain the contribution of General Practice staff to implementation of remote asthma consulting. Staff identified novel alternatives to in-person review. Having a practice champion to drive implementation forward, and engage other Practice staff, was important. Patient, staff and healthcare system contextual factors influencing implementation were identified including access to, understanding of and willingness to use the technology required for remote consulting.ConclusionThe experiences of frontline healthcare professionals in this study indicate that remote asthma consulting has potential benefits in terms of access and effectiveness when implementation integrates seamlessly with face-to-face care for those who want or need it. Work is required at Practice and healthcare system levels to realise this potential, and ensure implementation does not exacerbate existing healthcare inequalities.

Caregivers’ and healthcare professionals’ perspective of barriers and facilitators to health service access for asthmatic children: a qualitative study

BackgroundThere is a high burden of asthma morbidity and mortality in Latin America. It has been proposed that this relates to limited access to diagnostic tests, asthma medications and specialised doctors. However, little is known of what caregivers of asthmatic children and healthcare professionals (HCPs) perceive as barriers and facilitators to adequate care. We aimed to explore the barriers and facilitators to asthma care access from caregivers’ and HCP’s perspective in an Ecuadorian low-resource setting.MethodsIn 2017, we conducted 5 focus group discussions (FGD) with 20 caregivers of asthmatic children and 12 in-depth interviews with 3 paediatricians, 6 general doctors and 3 respiratory therapists in Esmeraldas city, Ecuador. FGDs and interviews were digitally recorded, transcribed, open-coded in QDA Miner, categorised using an interpretative phenomenological approach and analysed thematically. Barriers and facilitators were classified into availability, accessibility, acceptability and contact of healthcare services, based on Tanahashi model of health service access.ResultsLimited resources, use of alternative medicines, fear of medication side-effects and lack of specific training for doctors and knowledge in families were common barriers for both caregivers and HCPs. Caregivers and HCPs proposed the implementation of public health asthma-focused programmes that would include close community-based follow-up of people with asthma, educational sessions for their families and public engagement activities. HCPs also suggested implementing training programmes on asthma management for general doctors.ConclusionMultiple barriers identified by caregivers and HCPs referred to economic and health service organisational issues, fear of side effects of medication or ineffective self-management. Increasing caregivers and HCPs’ asthma knowledge, as well as HCPs’ communication skills to establish a patient-centred approach with a shared decision-making process could improve asthma care in this setting.

Effect and safety of an outpatient traditional medicine treatment for asthma in 26 patients from Cota, Colombia: a case series

The prevalence, morbidity and costs of asthma care have increased worldwide. This study describes the effect and safety of an outpatient medical treatment with traditional medicine for asthma, through a retrospective case series with patients admitted to outpatient consultation from 1995 to 2015 in Cota, Colombia. Analyzing 26 cases with a clinical diagnosis of asthma, during the treatment 34.6% (9/26) did not present episodes of uncontrolled asthma and 61.5% (16/26) were classified as controlled asthma in their last consultation of control. 88.4% (23/26) of the patients reported no adverse reactions and the three reported were mild. The results allow to generate hypotheses about the effectiveness and safety of an outpatient treatment based on the incorporation of resources from traditional medicine. These observations could be explored with experimental studies to determine their long-term effectiveness, safety and low cost.

Health workers’ perspectives on asthma care coordination between primary and specialised healthcare in the COVID-19 pandemic: a protocol for a qualitative study in Ecuador and Brazil

IntroductionAsthma is a common long-term disorder and strategies to improve asthma control are still a challenge. Integrated delivery of health systems is critical for effective asthma care: there is limited information on experiences of care coordination for asthma from Latin America, especially on perspectives of health personnel and in the context of the COVID-19 pandemic.Methods and analysisThis protocol details a qualitative approach to analyse health workers’ perspectives of healthcare coordination for asthma control during COVID-19 pandemic in Ecuador and Brazil, at primary and specialised levels, through in-depth semistructured interviews using a video communications platform. The analysis will identify knowledge and perspectives based on coordination of clinical information, clinical management and administrative coordination. Theoretical sampling will be used to obtain approximately equal numbers of women and men within each level of healthcare; data saturation will be used to determine sample size. Transcripts will be analysed using content-coding procedures to mark quotations related to major topics and subthemes included in the interview guide, and narrative analysis will be based on a theoretical framework for healthcare coordination to identify new themes and subthemes.Ethics and disseminationEthical approval was obtained from the ethics committees of Hospital General Docente Calderón, Quito, Ecuador; and Universidade Federal da Bahia, Salvador, Brazil. The findings of this study will be disseminated through peer-reviewed articles, conference presentations and condensed summaries for key stakeholders and partners.