Adherence to national guidelines for children with asthma at primary health centres in Sweden: potential for improvement

Abstract

Background: Although asthma is the most common chronic paediatric disease in Western Europe, the extent of adherence to guidelines for primary care management of paediatric asthma remains unclear.

Assessing appropriateness of paediatric asthma management: A population‐based sample survey

“…Fewer than 30% of children with persistent asthma received training on inhaler techniques (ASTH25; training on how to use inhaler device) or had their inhaler technique reassessed (ASTH26; assessment of inhaler technique). This is consistent with a report from Sweden where only 14% of children with asthma attending primary care received a demonstration of inhalation techniques . The first National Review of Asthma Deaths in UK, published in 2015, has identified appropriate regular assessment and documentation of inhaler technique by healthcare professionals as one of the key factors associated with improved care for people with asthma …”

“…This is consistent with a report from Sweden where only 14% of children with asthma attending primary care received a demonstration of inhalation techniques. 25 The first National Review of Asthma Deaths in UK, published in 2015, has identified appropriate regular assessment and documentation of inhaler technique by healthcare professionals as one of the key factors associated with improved care for people with asthma. 6…”

Health services received by individuals with duchenne/becker muscular dystrophy

“…Adherence studies in the Canadian health‐care system have indicated low (50%) adherence to baseline recommendations and even lower age‐based follow‐up adherence (15%) . A similar lack of adherence to pulmonary recommendations has been observed in children with asthma in Sweden, as <30% ever received recommended baseline testing or patient education for appropriate treatment application . There appears to be greater concurrence with cardiology recommendations, but baseline evaluation remains low at 56%.…”

“…Therefore, internal barriers, including familiarity, self‐efficacy, and practice inertia, or external barriers, such as an absence of resources, could be contributing to the lack of concurrence reported in the MD STARnet interviews. Physicians who take a holistic disease management approach are more likely to be familiar with and adhere to clinical practice recommendations, as would those with access to the specialist as part of the multidisciplinary clinic …”

Improving adherence in paediatric respiratory disease

“…Many patients adhere to an initial treatment prescription, but fail to persist with it, for example because they do not receive a repeat prescription or because they are not followed-up. Nonpersistence is extremely common for inhaled corticosteroids (ICS) [6], in particular in primary care where scheduled follow-up visits for children with asthma are the exception rather than the rule [7,8].…”