Aims: Amongst general practices in the NHS Borders region of Scotland, we aimed to determine compliance with the three key recommendations of the British Guideline for the Management of Asthma and to understand the nature of barriers and facilitators to their implementation.Methods: Using piloted audit tools, a researcher extracted data from computerised and/or paper patient medical records to assess compliance with recommendations for objective diagnosis and stepwise management. Provision of asthma action plans was assessed by patient survey. Clinicians' attitude to guidelines was assessed by postal survey.Results: Fifteen of the 24 practices in the NHS Borders region participated. Audited compliance with the three key recommendations varied markedly amongst and within practices. Whilst 367/547 (67%) of patients were treated appropriately with add-on therapy, only 58/254 (23%) of patients reported having been given an asthma action plan. Barriers to implementation identified by the clinicians' survey (response rate 64/84 -76%) were theoretical (doubt about the evidence base and relevance to primary care, lack of knowledge and skills, misconceptions) as well as practical (lack of time and resources) and were exacerbated by poor teamwork. Facilitators were good teamwork and appropriate organisation of work within the practice.Conclusions: Implementation of key recommendations was variable, particularly in the more complex intervention of issuing asthma action plans. An intervention to enhance compliance with these guideline recommendations will need to address both theoretical and practical barriers within the context of improved teamwork.
Background GP Clusters commenced across Scotland in 2016 to improve the quality of care of local populations Aim To determine GPs views on GP clusters, and the robustness of bespoke questions Design & setting Cross-sectional national survey of work satisfaction of GPs working in Scotland, conducted in the latter half of 2018 Method Analysis of bespoke questions on GP Clusters completed by a) Quality Leads (QLs), and b) all other GPs in a nationally representative sample of GPs. Results QLs reported that Clusters were meeting regularly and were friendly and well organised but not always productive. Support for cluster activity (data, health intelligence, analysis, quality improvement methods, advice, leadership, and evaluation) was sub-optimal. Factor analysis identified two separate constructs (cluster meetings and cluster support), which were minimally influenced (<2%) by GP and practice characteristics. Non-Quality Leads (75% of all GPs) were generally satisfied with the two-way communication with the cluster quality leads, but the great majority (> 70%) reported no positive changes in various aspects of quality improvement. Factor analysis of these items indicated two constructs (cluster communication and cluster quality improvement) which were minimally affected by GP and practice characteristics. Conclusion GP Clusters are ‘up and running’ in Scotland but are at an early stage in terms of perceived impact, and appear to be in need of more support in order to improve quality of care. The bespoke questions developed on clusters have robust construct validity, suitable for future surveys.
Background: Although the BTS-SIGN asthma guideline is one of the most well known and widely respected guidelines in the world, implementation in UK primary care remains patchy. Building on extensive earlier descriptive work, we sought to explore the way teamwork and inter-professional relationships impact on the implementation of the BTS-SIGN guideline on asthma in general practice.
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