WHAT PATIENTS REALLY THINK ABOUT ASTHMA GUIDELINES

FCAAIA Notes:  The first national guidelines for the diagnosis and treatment of asthma were published in 1993, with updates and revisions more recently.  Guidelines are just that-they are not rules or laws.  But, they are evidence based recommendations to help physicians maintain control of asthma, use as little medication necessary to do so, and to decrease the risk of complications of asthma.

It is important for our patients to understand the basis and rationale for our treatment recommendations.  They should ask any questions they have, but realize that “empowerment” is not just knowledge; it is in essence consent and agreement that comes from understanding. 

If you are not clear why we make certain recommendations for you, please ask! We prefer that than have you not try our suggestions.

(Source: http://www.medscape.com/viewarticle/884031?nlid=117567_3821&src=WNL_mdplsfeat_170829_mscpedit_aimm&uac=112079PK&spon=38&impID=1421329&faf=1 August 29, 2017. For Medscape articles: User name: FCAAIA, Password: Allergies)

Abstract

Background: Treatment 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 analyzed the patients’ perspective of a “good asthma therapy” and contrasted their wishes with current recommendations.

Methods: Using a qualitative exploratory design, topic centered 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 analyzed 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.

Results: Thirteen 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.

Conclusions: We 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.

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