Improving primary care management of asthma: do we know what really works?
Monica Fletcher, Ioanna Tsiligianni, Janwillem Kocks, Andrew Cave, Chi Chunhua, Jaime Correia de Sousa, Miguel Román-Rodríguez, Mike Thomas, Péter Kardos, Carol Stonham, Ee Ming Khoo, David Leather, Thys van der Molen
Abstract
Asthma imposes a substantial burden on individuals and societies. Patients with asthma need high-quality primary care management; however, evidence suggests the quality of this care can be highly variable. Here we identify and report factors contributing to high-quality management. Twelve primary care global asthma experts, representing nine countries, identified key factors. A literature review (past 10 years) was performed to validate or refute the expert viewpoint. Key driving factors identified were: policy, clinical guidelines, rewards for performance, practice organisation and workforce. Further analysis established the relevant factor components. Review evidence supported the validity of each driver; however, impact on patient outcomes was uncertain. Single interventions (e.g. healthcare practitioner education) showed little effect; interventions driven by national policy (e.g. incentive schemes and teamworking) were more effective. The panel's opinion, supported by literature review, concluded that multiple primary care interventions offer greater benefit than any single intervention in asthma management.